Provider Demographics
NPI:1699260802
Name:EZ CARE IOWA LLC
Entity type:Organization
Organization Name:EZ CARE IOWA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:337-358-2701
Mailing Address - Street 1:621 E MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:IOWA
Mailing Address - State:LA
Mailing Address - Zip Code:70647
Mailing Address - Country:US
Mailing Address - Phone:337-358-2701
Mailing Address - Fax:337-358-2706
Practice Address - Street 1:621 E. MILLER AVENUE
Practice Address - Street 2:
Practice Address - City:IOWA
Practice Address - State:LA
Practice Address - Zip Code:70647-7064
Practice Address - Country:US
Practice Address - Phone:337-884-4890
Practice Address - Fax:337-548-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317377Medicaid