Provider Demographics
NPI:1902578008
Name:LILL, QUANAE (APRN-RX)
Entity Type:Individual
Prefix:MS
First Name:QUANAE
Middle Name:
Last Name:LILL
Suffix:
Gender:F
Credentials:APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 N KALAHEO AVE STE A214
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1857
Mailing Address - Country:US
Mailing Address - Phone:808-238-1953
Mailing Address - Fax:
Practice Address - Street 1:970 N KALAHEO AVE STE A214
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1857
Practice Address - Country:US
Practice Address - Phone:808-941-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-3304363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty