Provider Demographics
NPI:1568825172
Name:LILLEY, OSCAR
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:LILLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PALMER DR
Mailing Address - Street 2:APT. 4
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-4774
Mailing Address - Country:US
Mailing Address - Phone:307-760-8890
Mailing Address - Fax:
Practice Address - Street 1:1520 PALMER DR
Practice Address - Street 2:APT. 4
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-4774
Practice Address - Country:US
Practice Address - Phone:307-760-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker