Colleen Lillie
Individual provider Active NPI Registered Nurse · Umatilla, OR
NPI 1063963569 · NPPES record last updated Oct 19, 2016
Key facts
- NPI
- 1063963569
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 081001417RN (OR)
- Practice address
- 290 Willamette St
Umatilla, OR 97882-6601 - Phone
- (541) 922-0880
- NPI assigned
- Oct 19, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 081001417RN | OR | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifeways, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 081001417RN | OR | Yes |
Addresses
Primary practice location
290 Willamette St
Umatilla, OR 97882-6601
Mailing address
702 Sunset Dr
Ontario, OR 97914-3121
Other providers in Umatilla, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.