MEDICARE: LILLIES HOME HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1588427652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LILLIES HOME HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	2041 BONISLE CIR
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33418-6504
Country	:	US
Telephone Number	:	561-598-0446
Fax Number	:	561-258-0582

Provider Business Practice Location Address
First Line	:	2041 BONISLE CIR
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33418-6504
Country	:	US
Telephone Number	:	561-598-0446
Fax Number	:	561-258-0582

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	MR. LILLIE MAE WHITEHURST
Credential	:	ARNP
Telephone Number	:	561-598-0446

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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