Provider Demographics
NPI:1891110292
Name:LILY, GAIL
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LILY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:SUSAN
Other - Last Name:WEISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1015 S BIRCH ST APT 307A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2519
Mailing Address - Country:US
Mailing Address - Phone:303-525-0154
Mailing Address - Fax:
Practice Address - Street 1:3636 S PEARL ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3806
Practice Address - Country:US
Practice Address - Phone:303-761-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0168468163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation