Provider Demographics
NPI:1366952020
Name:PAKAWONGSE, LILLY (RN, MSN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:PAKAWONGSE
Suffix:
Gender:F
Credentials:RN, MSN, CPNP-PC
Other - Prefix:
Other - First Name:LILLY
Other - Middle Name:
Other - Last Name:FELDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, CPNP-PC
Mailing Address - Street 1:2425 GEARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3358
Mailing Address - Country:US
Mailing Address - Phone:510-541-1101
Mailing Address - Fax:
Practice Address - Street 1:2970 HILLTOP MALL RD STE 305
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5274
Practice Address - Country:US
Practice Address - Phone:510-222-5437
Practice Address - Fax:510-222-5487
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95066338163W00000X
CA95007505363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse