Individual
KATHLEEN ANN LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
525 CLINTON ST, DETROIT, MI 48226-2317
(313) 224-2247
Mailing address
525 CLINTON ST, DETROIT, MI 48226-2317
(313) 224-2247
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-180664
AL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704406562
MI
Other
Enumeration date
03/24/2022
Last updated
10/05/2023
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