Provider Demographics
NPI:1417778465
Name:NIESTER, LILLI
Entity type:Individual
Prefix:
First Name:LILLI
Middle Name:
Last Name:NIESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 E GELDING DR STE D-101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6983
Mailing Address - Country:US
Mailing Address - Phone:602-836-4673
Mailing Address - Fax:
Practice Address - Street 1:8080 E GELDING DR STE D-101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6983
Practice Address - Country:US
Practice Address - Phone:602-836-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24-1893175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath