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NPI Code Detail

MEDICARE: LILA SULLIVAN

MEDICARE: LILA SULLIVAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse043069581IL

General Provider Information

NPI Number : 1073884904
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILA SULLIVAN
Provider Business Mailing Address
First Line : 1810 W SOUTH 3RD ST
Second Line :
City : SHELBYVILLE
State : IL
Zip : 62565-9595
Country : US
Telephone Number : 217-774-2113
Fax Number :
Provider Business Practice Location Address
First Line : 1810 W SOUTH 3RD ST
Second Line :
City : SHELBYVILLE
State : IL
Zip : 62565-9595
Country : US
Telephone Number : 217-774-2113
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2012
Last Update Date : 01/24/2012

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Directions to “ LILA SULLIVAN ” Practice Location

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