Healthcare Provider Details

I. General information

NPI: 1639173172
Provider Name (Legal Business Name): NANCY G LILLEHEI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AUBURN AVE STE 200
AUBURN WA
98002-5057
US

IV. Provider business mailing address

PO BOX 24931
SEATTLE WA
98124-0931
US

V. Phone/Fax

Practice location:
  • Phone: 253-288-2140
  • Fax:
Mailing address:
  • Phone: 425-353-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00028153
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: