Provider Demographics
NPI:1487367066
Name:NAMANWORTH, LILY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:NAMANWORTH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 HUDSON MANOR TER APT 6AB
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1137
Mailing Address - Country:US
Mailing Address - Phone:347-572-4932
Mailing Address - Fax:
Practice Address - Street 1:49 FOREST RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2923
Practice Address - Country:US
Practice Address - Phone:845-782-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY383034363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics