Healthcare Provider Details

I. General information

NPI: 1093620791
Provider Name (Legal Business Name): LILLIE PHILLIPS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CAMPUS DR
LANSDALE PA
19446-1259
US

IV. Provider business mailing address

202 N MAIN ST # 204A
CHALFONT PA
18914-2926
US

V. Phone/Fax

Practice location:
  • Phone: 423-262-9366
  • Fax:
Mailing address:
  • Phone: 423-262-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP035788
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: