Individual
KELLY LYNN LILLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
2440 BRIDGE AVE, ALBERT LEA, MN 56007-2088
(507) 320-7900
(507) 320-7900
Mailing address
621 S ILLINOIS AVE STE 103, MASON CITY, IA 50401-5489
(641) 428-3041
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R2065946
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
Enumeration date
07/11/2012
Last updated
03/13/2024
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