Healthcare Provider Details

I. General information

NPI: 1609852607
Provider Name (Legal Business Name): ANN F LILLIS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MAPLE RD STE 1
WILLIAMSVILLE NY
14221-2917
US

IV. Provider business mailing address

60 MAPLE RD STE 1
WILLIAMSVILLE NY
14221-2917
US

V. Phone/Fax

Practice location:
  • Phone: 716-626-5250
  • Fax: 716-332-2218
Mailing address:
  • Phone: 716-626-5250
  • Fax: 716-332-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF301173
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: