Healthcare Provider Details

I. General information

NPI: 1386049922
Provider Name (Legal Business Name): LILLIA ST. CLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CAMP ST
PROVIDENCE RI
02906-1944
US

IV. Provider business mailing address

224 CAMP ST
PROVIDENCE RI
02906-1944
US

V. Phone/Fax

Practice location:
  • Phone: 401-632-9539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN32658
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: