Provider Demographics
NPI:1144642638
Name:OANDAH, LILLIAN (FNP)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:OANDAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GUS THOMASSON RD STE 117
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6729
Mailing Address - Country:US
Mailing Address - Phone:612-201-5140
Mailing Address - Fax:
Practice Address - Street 1:3600 GUS THOMASSON RD STE 117
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6729
Practice Address - Country:US
Practice Address - Phone:612-201-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX775037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily