Healthcare Provider Details

I. General information

NPI: 1669094751
Provider Name (Legal Business Name): LILA WOOTEN DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2877 E FOUNTAIN BLVD
COLORADO SPRINGS CO
80910-2312
US

IV. Provider business mailing address

PO BOX 746081
ATLANTA GA
30374-6081
US

V. Phone/Fax

Practice location:
  • Phone: 719-454-6009
  • Fax: 719-258-1319
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0999876
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61057103
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberEP61078944
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberN261065345
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: