Individual
MS. MARY P LILLICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D. L.D.
Contact information
Practice address
5413 RIVER RD, AMARILLO, TX 79108-4607
(806) 381-4322
(806) 381-4322
Mailing address
5413 RIVER RD, AMARILLO, TX 79108-4607
(806) 381-4322
(806) 381-4322
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT02437
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8K8622
LINK TO 00BF18
TX
Enumeration date
03/29/2007
Last updated
07/09/2007
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