Healthcare Provider Details

I. General information

NPI: 1568605657
Provider Name (Legal Business Name): DEENA S LILLEY ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD STE 300
RALEIGH NC
27607-6476
US

IV. Provider business mailing address

1025 CHESSRIDGE WAY
MORRISVILLE NC
27560-6011
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7874
  • Fax:
Mailing address:
  • Phone: 919-609-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5006971
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: