Provider Demographics
NPI:1548917099
Name:LILES, DARIENNE N (CNM)
Entity type:Individual
Prefix:
First Name:DARIENNE
Middle Name:N
Last Name:LILES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 STATE ROUTE 73
Mailing Address - Street 2:
Mailing Address - City:MC DERMOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45652-8857
Mailing Address - Country:US
Mailing Address - Phone:606-939-1329
Mailing Address - Fax:740-353-1258
Practice Address - Street 1:1735 27TH ST STE 206A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-0009
Practice Address - Country:US
Practice Address - Phone:740-353-3196
Practice Address - Fax:740-353-1258
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH439462163W00000X
OHAPRN.CNM.0019529367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100837160Medicaid
OH0497680Medicaid