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General NPI Number Information
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NPI Number | 1194946012
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Entity Type | Individual
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Provider Name | JOAN ILI PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 950 BROADWAY STE 404
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City | TACOMA
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State | WA
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Zip | 98402-4454
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Country | US
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Telephone | 425-640-7009
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Fax | 425-678-6455
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Provider Business Mailing Address
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Address Line | 2824 N POWER RD STE 113-152
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City | MESA
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State | AZ
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Zip | 85215-1672
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Country | US
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Telephone | 503-487-5954
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN61112406
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 243826
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License Number State | AZ
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