Healthcare Provider Details

I. General information

NPI: 1710242300
Provider Name (Legal Business Name): JANA MARIE LILYERD ANP/GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S BEHL ST
APPLETON MN
56208-1616
US

IV. Provider business mailing address

30 S BEHL ST
APPLETON MN
56208-1616
US

V. Phone/Fax

Practice location:
  • Phone: 320-289-2422
  • Fax: 320-289-1585
Mailing address:
  • Phone: 320-289-2422
  • Fax: 320-289-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR161003-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: