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General NPI Number Information
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NPI Number | 1699260802
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Entity Type | Organization
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Legal Business Name | EZ CARE IOWA LLC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 621 E. MILLER AVENUE
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City | IOWA
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State | LA
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Zip | 70647-7064
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Country | US
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Telephone | 337-884-4890
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Fax | 337-548-9176
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Provider Business Mailing Address
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Address Line | 621 E MILLER AVE
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City | IOWA
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State | LA
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Zip | 70647
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Country | US
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Telephone | 337-358-2701
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Fax | 337-358-2706
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Authorized Official
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Title or Position | OWNER/ FAMILY NURSE PRACTITIONER
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Name | DR. SAMANTHA G LILLEY
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Credential | DNP, APRN, FNP-BC
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Telephone | 337-358-2701
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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 | AP06818
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License Number State | LA
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