Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 41934-020 | WI |
Y | 111NI0900X | Internist | 41934-020 | WI |
N | 207RH0002X | Hospice and Palliative Medicine | 41934-020 | WI |
NPI | 1104872670 |
---|---|
Provider Name | Kathryn A Lilley |
First Address | Janesville, WI 53546-2343 |
Second Address | Janesville, WI 53546-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104872670 | (05) | WI |
G17393 | (02) |