Individual
DIANE L LILJEGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3100 TONGASS AVE, KETCHIKAN, AK 99901-5746
(907) 228-8140
(907) 228-8440
Mailing address
3100 TONGASS AVE, KETCHIKAN, AK 99901-5746
(907) 228-8300
(907) 228-8518
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2793
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201207
WASHINGTON L&I
—
05
—
MD27931
—
AK
Enumeration date
07/05/2006
Last updated
05/15/2008
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