Provider Demographics
NPI:1518062116
Name:LILLIE, NANCY SPENCE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SPENCE
Last Name:LILLIE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W GLOUCESTER ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2032
Mailing Address - Country:US
Mailing Address - Phone:503-866-9038
Mailing Address - Fax:503-656-4921
Practice Address - Street 1:135 W GLOUCESTER ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2032
Practice Address - Country:US
Practice Address - Phone:503-866-9038
Practice Address - Fax:503-656-4921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078010801N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health