Provider Demographics
NPI:1962778456
Name:LILLENESS, ERICA LOUISE (DO)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LOUISE
Last Name:LILLENESS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E PIONEER STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3256
Mailing Address - Country:US
Mailing Address - Phone:253-445-5828
Mailing Address - Fax:253-445-5831
Practice Address - Street 1:400 E PIONEER STE 101
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3256
Practice Address - Country:US
Practice Address - Phone:253-445-5828
Practice Address - Fax:253-445-5831
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3072-321207L00000X
WAOP60651051207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology