Provider Demographics
NPI:1316648363
Name:SHONTZ, LILY (MSN, RN, A-GNP-C)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:SHONTZ
Suffix:
Gender:F
Credentials:MSN, RN, A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 STAMFORD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3520
Mailing Address - Country:US
Mailing Address - Phone:609-744-7688
Mailing Address - Fax:
Practice Address - Street 1:5401 OLD YORK ROAD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-6127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027162363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care