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General NPI Number Information
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NPI Number | 1588055719
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Entity Type | Individual
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Provider Name | LILIETH J INNIS ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1201 PACIFIC AVE STE C6
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City | TACOMA
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State | WA
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Zip | 98402-4393
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Country | US
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Telephone | 557-229-7008
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Fax |
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Provider Business Mailing Address
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Address Line | 8195 BELVEDERE RD APT. 201
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-6235
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Country | US
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Telephone | 609-332-1542
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9398858
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60886780
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License Number State | WA
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