Individual
STEPHANIE LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3901 BEAR CREEK BLVD, BEAR CREEK TOWNSHIP, PA 18702-9752
(570) 574-4611
Mailing address
3901 BEAR CREEK BLVD, BEAR CREEK TOWNSHIP, PA 18702-9752
(570) 574-4611
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN587980
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP019836
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103612815-0001
—
PA
Enumeration date
10/25/2018
Last updated
03/19/2024
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