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MR. RUSSELL WILLIAM LILLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
832 KOSSUTH ST, FREEMANSBURG, PA 18017-7117
(610) 704-1479
Mailing address
832 KOSSUTH ST, FREEMANSBURG, PA 18017-7117
(610) 704-1479

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP02014
PA

Other

Enumeration date
02/15/2022
Last updated
04/30/2024
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