MEDICARE: LILLIAN MARIE ANDERSON FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	RN10000420	MA

General Provider Information

NPI Number	:	1639036502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN MARIE ANDERSON FNP-BC

Provider Business Mailing Address
First Line	:	771 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	771 BROADWAY
Second Line	:
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2111
Country	:	US
Telephone Number	:	978-399-8305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ LILLIAN MARIE ANDERSON FNP-BC” Practice Location

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