Provider Demographics
NPI:1386153633
Name:LILLY, WHITNEY V (FNP-C)
Entity type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:V
Last Name:LILLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0550
Mailing Address - Country:US
Mailing Address - Phone:855-397-0197
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:102 S. EUCLID AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-4939
Practice Address - Country:US
Practice Address - Phone:208-263-6876
Practice Address - Fax:208-263-2033
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201708936NP-PP363L00000X
ID57882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200941379RNOtherOREGON STATE BOARD OF NURSING
OR201708936NP-PPOtherOREGON STATE BOARD OF NURSING