Healthcare Provider Details

I. General information

NPI: 1851065189
Provider Name (Legal Business Name): LILY RAE BATCHELOR NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

1607 E 23RD AVE
DENVER CO
80205-5346
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-5555
  • Fax:
Mailing address:
  • Phone: 720-937-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number104520818
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1653866
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: