Provider Demographics
NPI:1407608995
Name:LILLEY, AMANDA W (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:W
Last Name:LILLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-9344
Mailing Address - Country:US
Mailing Address - Phone:252-945-9390
Mailing Address - Fax:
Practice Address - Street 1:1970 W ARLINGTON BLVD STE B2
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5783
Practice Address - Country:US
Practice Address - Phone:252-945-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC246621163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health