Provider Demographics
NPI:1609041946
Name:LILLWITZ, ANNE MARIE
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:LILLWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 KESLINGER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3753
Mailing Address - Country:US
Mailing Address - Phone:630-232-7200
Mailing Address - Fax:630-232-2288
Practice Address - Street 1:2800 KESLINGER RD STE 160
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3753
Practice Address - Country:US
Practice Address - Phone:630-232-7200
Practice Address - Fax:630-232-2288
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000507363L00000X
IL209000808363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILML0731198OtherDEA NUMBER