Provider Demographics
NPI:1912653429
Name:LILLY, ASHLEIGH KAITLIN (CNA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:KAITLIN
Last Name:LILLY
Suffix:
Gender:F
Credentials:CNA
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 98
Mailing Address - Street 2:
Mailing Address - City:MAKOTI
Mailing Address - State:ND
Mailing Address - Zip Code:58756-0098
Mailing Address - Country:US
Mailing Address - Phone:701-651-8850
Mailing Address - Fax:
Practice Address - Street 1:310 WARD ST
Practice Address - Street 2:
Practice Address - City:MAKOTI
Practice Address - State:ND
Practice Address - Zip Code:58756-0098
Practice Address - Country:US
Practice Address - Phone:701-651-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND768973747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant