Individual
JACQUELINE DIANE LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD APRN BC
Contact information
Practice address
102 WEST UTICA STREET, OSWEGO, NY 13126
(315) 342-2450
Mailing address
102 WEST UTICA STREET, OSWEGO, NY 13126
(315) 342-2450
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
RN2539751
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7493000
VALUE OPTIONS
—
Enumeration date
08/26/2006
Last updated
10/17/2007
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