Provider Demographics
NPI:1962703926
Name:LILLEY, DEBORAH CANNON (LPN)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:CANNON
Last Name:LILLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 QUAIL RIDGE RD APT B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5586
Mailing Address - Country:US
Mailing Address - Phone:910-340-1027
Mailing Address - Fax:
Practice Address - Street 1:2043 QUAIL RIDGE RD APT B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5586
Practice Address - Country:US
Practice Address - Phone:910-340-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC028788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse