Individual
ANGELA LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8419 BOYKO FARM, CICERO, NY 13039-8747
(315) 317-9308
Mailing address
8419 BOYKO FARM, CICERO, NY 13039
(315) 317-9308
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
258564-01
NY
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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