Individual
LILLIAN E MARESCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
73265 CONFEDERATED WAY, PENDLETON, OR 97801-0160
(541) 966-9830
(541) 278-7575
Mailing address
2306 PALOUSE ST, BOISE, ID 83705-3565
(208) 378-4288
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6636
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346283488
TRIBAL CLINIC NPPES
OR
05
—
171037
—
OR
01
—
8TA265
MEDICARE/TRAILBLAZER
OR
Enumeration date
05/12/2006
Last updated
09/20/2011
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