Individual
JEFFREY LILLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 260-4300
(505) 260-4371
Mailing address
1720 LOUISIANA BLVD NE STE 401, ALBUQUERQUE, NM 87110-7020
(505) 260-4300
(505) 260-4371
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
58578
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/14/2019
Last updated
12/11/2019
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