Individual
TRAVIS LILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Mailing address
900 PEELER ST, KALAMAZOO, MI 49008-2300
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704312699
MI
367500000X
Certified Registered Nurse Anesthetist
RN158828
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704312699
MICHIGAN LICENSE
MI
Enumeration date
04/22/2015
Last updated
04/11/2016
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