Provider Demographics
NPI:1639731854
Name:AYEMA, LILLIAN (LPN, BS)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:
Last Name:AYEMA
Suffix:
Gender:F
Credentials:LPN, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MARKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6910
Mailing Address - Country:US
Mailing Address - Phone:662-275-2597
Mailing Address - Fax:
Practice Address - Street 1:1229 MARKHAM AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6910
Practice Address - Country:US
Practice Address - Phone:662-275-2597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP313959164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse