Healthcare Provider Details

I. General information

NPI: 1114326287
Provider Name (Legal Business Name): ALICE PENELOPE LILLY BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 BOUNTIFUL WAY
LAS VEGAS NV
89121-5777
US

IV. Provider business mailing address

4635 BOUNTIFUL WAY
LAS VEGAS NV
89121-5777
US

V. Phone/Fax

Practice location:
  • Phone: 949-418-2438
  • Fax:
Mailing address:
  • Phone: 949-418-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: