Provider Demographics
NPI:1710242300
Name:LILYERD, JANA MARIE (ANP/GNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MARIE
Last Name:LILYERD
Suffix:
Gender:F
Credentials:ANP/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S BEHL ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208-1616
Mailing Address - Country:US
Mailing Address - Phone:320-289-2422
Mailing Address - Fax:320-289-1585
Practice Address - Street 1:30 S BEHL ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208-1616
Practice Address - Country:US
Practice Address - Phone:320-289-2422
Practice Address - Fax:320-289-1585
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR161003-3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR161003-3OtherMINNESOTA LICENSE IDENTIFICATION NUMBER