Provider Demographics
NPI:1235922113
Name:OTOKHAGUA, LILLIAN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:OTOKHAGUA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1725
Mailing Address - Country:US
Mailing Address - Phone:978-726-6686
Mailing Address - Fax:
Practice Address - Street 1:101 MARTIN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1725
Practice Address - Country:US
Practice Address - Phone:978-726-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2025021805363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health