Provider Demographics
NPI:1194946012
Name:ILI, JOAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ILI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 N POWER RD STE 113-152
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1672
Mailing Address - Country:US
Mailing Address - Phone:503-487-5954
Mailing Address - Fax:
Practice Address - Street 1:950 BROADWAY STE 404
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4454
Practice Address - Country:US
Practice Address - Phone:425-640-7009
Practice Address - Fax:425-678-6455
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61112406363LP0808X
AZ243826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health