Provider Demographics
NPI:1619033388
Name:LILLICRAF, KATHLEEN A (PA)
Entity Type:Individual
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First Name:KATHLEEN
Middle Name:A
Last Name:LILLICRAF
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Gender:F
Credentials:PA
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Mailing Address - Street 1:99 EAST RIVER DRIVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-0833
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:JOHN DEMPSEY HOSPITAL: DEPT OF ANESTHESIOLOGY
Practice Address - Street 2:263 FARMINGTON AVENUE, MC-2015
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-4142
Practice Address - Fax:860-679-1275
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-04-18
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Provider Licenses
StateLicense IDTaxonomies
CT000819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant