Individual
MR. LARRY LEE LILLEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NNP
Contact information
Practice address
627 ARAGONA DR, VINTON, VA 24179-2807
(540) 342-1004
Mailing address
627 ARAGONA DR, VINTON, VA 24179-2807
(540) 342-1004
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
0001190201
VA
Other
Enumeration date
03/14/2010
Last updated
03/14/2010
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