Provider Demographics
NPI:1336207315
Name:LILES, MARIANNE THERESA (NPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:THERESA
Last Name:LILES
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:THERESA
Other - Last Name:MCCUSKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NPC
Mailing Address - Street 1:1012 N CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2722
Mailing Address - Country:US
Mailing Address - Phone:302-593-3630
Mailing Address - Fax:
Practice Address - Street 1:7TH AND CLAYTON STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-421-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003210I23Medicare PIN