Provider Demographics
NPI:1891556031
Name:LILLIE, ALEXANDRA RYAN (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RYAN
Last Name:LILLIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1160 S MICHIGAN AVE APT 2606
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3046
Mailing Address - Country:US
Mailing Address - Phone:586-219-5472
Mailing Address - Fax:
Practice Address - Street 1:1160 S MICHIGAN AVE APT 2606
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3046
Practice Address - Country:US
Practice Address - Phone:586-219-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-10-03
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant