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General NPI Number Information
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NPI Number | 1639649486
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Entity Type | Individual
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Provider Name | LILIAN M PUMAH APN
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Gender | Female
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 08/17/2024
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Provider Practice Location Address
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Address Line | 581 ELM PL STE 110
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3122
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Country | US
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Telephone | 847-861-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 LITTLE JOHN CT
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2124
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Country | US
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Telephone | 224-619-9310
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.018484
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG06180135
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.018484
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License Number State | IL
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