Provider Demographics
NPI:1962437152
Name:MANDL, LILLIAN R (APRN)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:R
Last Name:MANDL
Suffix:
Gender:F
Credentials:APRN
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Other - Credentials:
Mailing Address - Street 1:MAINE COMPREHENSIVE PAIN MANAGEMENT, P.C.
Mailing Address - Street 2:400 ENTERPRISE DRIVE, SUITE 1
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7663
Mailing Address - Country:US
Mailing Address - Phone:207-289-6726
Mailing Address - Fax:207-289-1219
Practice Address - Street 1:MAINE COMPREHENSIVE PAIN MANAGEMENT, P.C.
Practice Address - Street 2:400 ENTERPRISE DRIVE, SUITE 1
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7663
Practice Address - Country:US
Practice Address - Phone:207-289-6726
Practice Address - Fax:207-289-1219
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2024-06-13
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Provider Licenses
StateLicense IDTaxonomies
NH03067523363L00000X
MEMM3521742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME301090099Medicaid
NH30341057Medicaid
NH30341057Medicaid
ME301090099Medicaid