Active NPI
Mitchell Raymond Lilly, LPN
- Registered Nurse
- Joliet, IL
National Provider Identifier
1619698065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- PN5239605
- Practice address
- 3114 Nantucket Dr
Joliet, IL 60435-9023 - Phone
- (815) 483-1873
- NPI assigned
- Sep 5, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | PN5239605 | FL | Primary |
Addresses
Primary practice location
3114 Nantucket Dr
Joliet, IL 60435-9023
Mailing address
3114 Nantucket Dr
Joliet, IL 60435-9023
Phone (815) 483-1873
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Willy8852003@yahoo.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN5239605 | FL | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662336000000",
"number": "1619698065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3114 NANTUCKET DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604359023",
"telephone_number": "815-483-1873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3114 NANTUCKET DR",
"city": "JOLIET",
"state": "IL",
"postal_code": "604359023",
"telephone_number": "815-483-1873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLY",
"first_name": "MITCHELL",
"middle_name": "RAYMOND",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-05",
"last_updated": "2022-09-05",
"certification_date": "2022-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "PN5239605",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Willy8852003@yahoo.com",
"affiliation": "N",
"address_1": "3114 Nantucket Dr",
"city": "Joliet",
"state": "IL",
"country_code": "US",
"postal_code": "604359023",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.