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General NPI Number Information
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NPI Number | 1124323621
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Entity Type | Individual
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Provider Name | MELISSA R LILL CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 483 W. SEED FARM RD
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City | SACATON
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State | AZ
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Zip | 85147
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Country | US
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Telephone | 602-528-1200
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Fax | 602-528-1255
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | SACATON
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State | AZ
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Zip | 85147-0001
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Country | US
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Telephone | 602-528-1200
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Fax | 602-528-1255
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP4366
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | SP011112
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License Number State | PA
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