Provider Demographics
NPI:1558968594
Name:UZZAMAN, LILY A (FNP STUDENT)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:A
Last Name:UZZAMAN
Suffix:
Gender:F
Credentials:FNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51377 SW OLD PORTLAND RD STE C
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-4023
Mailing Address - Country:US
Mailing Address - Phone:503-418-4222
Mailing Address - Fax:
Practice Address - Street 1:52377 SW OLD PORTLAND RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056
Practice Address - Country:US
Practice Address - Phone:503-418-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202212410NP-PP363LF0000X
OR201240897RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse