Provider Demographics
NPI:1548504921
Name:PAVLIK, LILLIAN MEYERS (FNP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MEYERS
Last Name:PAVLIK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1945
Mailing Address - Country:US
Mailing Address - Phone:360-676-9336
Mailing Address - Fax:360-676-2567
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-676-9336
Practice Address - Fax:360-676-2567
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60683017363LF0000X
WAN360685232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8956915Medicare UPIN