Provider Demographics
NPI:1558428938
Name:MCILWAINE, LIANE PALISOUL (MA)
Entity Type:Individual
Prefix:MRS
First Name:LIANE
Middle Name:PALISOUL
Last Name:MCILWAINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3719 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1606
Mailing Address - Country:US
Mailing Address - Phone:307-632-8911
Mailing Address - Fax:307-433-0487
Practice Address - Street 1:3719 DOVER RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1606
Practice Address - Country:US
Practice Address - Phone:307-632-8911
Practice Address - Fax:307-433-0487
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator