Individual
JACKIE SUE LILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3209 TOWNSHIP ROAD 31 N, HUNTSVILLE, OH 43324-7501
(937) 869-2256
Mailing address
3209 TOWNSHIP ROAD 31 N, HUNTSVILLE, OH 43324-7501
(937) 869-2256
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN124987-IV
OH
Other
Enumeration date
04/04/2025
Last updated
04/04/2025
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