Provider Demographics
NPI:1609852607
Name:LILLIS, ANN F (ANP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:F
Last Name:LILLIS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:60 MAPLE RD
Mailing Address - Street 2:STE 1
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2917
Mailing Address - Country:US
Mailing Address - Phone:716-626-5250
Mailing Address - Fax:716-332-2218
Practice Address - Street 1:60 MAPLE RD
Practice Address - Street 2:STE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2917
Practice Address - Country:US
Practice Address - Phone:716-626-5250
Practice Address - Fax:716-332-2218
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF301173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027009201OtherUNIVERA
NY9512113OtherINDEPENDENT HEALTH
NY000560817002OtherBLUE CROSS OF WNY
NY02502481Medicaid
NY9512113OtherINDEPENDENT HEALTH
NY000560817002OtherBLUE CROSS OF WNY