Provider Demographics
NPI:1912362518
Name:LILLEY, ANDREA (MS, RN, CDCES)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LILLEY
Suffix:
Gender:F
Credentials:MS, RN, CDCES
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:LILLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RN, CDCES
Mailing Address - Street 1:344 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3647
Mailing Address - Country:US
Mailing Address - Phone:518-512-5171
Mailing Address - Fax:
Practice Address - Street 1:344 FULLER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3647
Practice Address - Country:US
Practice Address - Phone:518-512-5171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY514219163W00000X
NY21420118133N00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No133N00000XDietary & Nutritional Service ProvidersNutritionist