Provider Demographics
NPI:1356990451
Name:LILES, DANA MARIE (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:LILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-402-5001
Mailing Address - Fax:
Practice Address - Street 1:501 CARNES CROSSING BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0407
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:843-203-2299
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23265363LF0000X
SC75048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6358Medicaid