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General NPI Number Information
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NPI Number | 1922168517
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Entity Type | Individual
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Provider Name | JAMIE MARIA LILLY PA
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 500 WEST BROADWAY
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City | MISSOULA
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State | MT
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Zip | 59802
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Country | US
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Telephone | 406-329-5615
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Fax | 406-329-2791
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Provider Business Mailing Address
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Address Line | 500 WEST BROADWAY
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City | MISSOULA
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State | MT
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Zip | 59802-4096
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Country | US
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Telephone | 406-329-5615
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Fax | 406-329-2791
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 055-0031195
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 001000729
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0670
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 69994
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License Number State | MT
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