Most Relevant Information
Provider Data
| NPI Number: | 1003290206 |
| Provider Name: | AMANDA NICOLE LILLY CNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | NP17720 |
Most Important Dates
| Enumeration Date: | 07/17/2015 |
| Last Updated: | 05/14/2021 |
Provider Practice Location
600 W 3RD ST
MANSFIELD
OH
449062633
Practice Location Phone/Fax
| Phone: | 4195226191 |
| Fax: | 4195256723 |
Provider Mailing Location
600 W 3RD ST
MANSFIELD
OH
449062633
Provider Mailing Phone/Fax
| Phone: | 4195226191 |
| Fax: | 4195256723 |