Healthcare Provider Details

I. General information

NPI: 1891460481
Provider Name (Legal Business Name): BETHANY LYN LILLY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

318 EMBURY RD
ROCHESTER NY
14625-1150
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-3760
  • Fax:
Mailing address:
  • Phone: 585-410-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348131
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number348131
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: