Provider Demographics
NPI:1255390910
Name:LILLIOTT, NANCY LM (RN NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LM
Last Name:LILLIOTT
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 WARING RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4405
Mailing Address - Country:US
Mailing Address - Phone:760-724-9000
Mailing Address - Fax:760-724-3686
Practice Address - Street 1:3905 WARING RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4405
Practice Address - Country:US
Practice Address - Phone:760-724-9000
Practice Address - Fax:760-724-3686
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92056B009OtherCHAMPUS
CAWNP11643AMedicare ID - Type UnspecifiedMCARE PROV NUMBER
CAP10705Medicare UPIN