Provider Demographics
NPI:1265649883
Name:NDIRIPO, LILIAN
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:NDIRIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:
Other - Last Name:MAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:403 NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1154
Mailing Address - Country:US
Mailing Address - Phone:484-800-2386
Mailing Address - Fax:
Practice Address - Street 1:403 NAVAJO DR
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1154
Practice Address - Country:US
Practice Address - Phone:484-800-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN271198164W00000X
PASP028400363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse