MEDICARE: ALICIA LILLY REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	174547	CO

General Provider Information

NPI Number	:	1003267758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA LILLY REGISTERED NURSE

Provider Business Mailing Address
First Line	:	18930 E 43RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7145
Country	:	US
Telephone Number	:	720-374-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	18930 E 43RD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7145
Country	:	US
Telephone Number	:	720-374-1070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	06/23/2016

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