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NPI Code Detail

MEDICARE: NICOLE MARIE LILLY AU.D

MEDICARE: NICOLE MARIE LILLY AU.D
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
1231H00000XAudiologist689CO

General Provider Information

NPI Number : 1518228808
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE LILLY AU.D
Provider Business Mailing Address
First Line : 320 E 1ST AVE STE 102
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-3786
Country : US
Telephone Number : 303-464-8440
Fax Number :
Provider Business Practice Location Address
First Line : 320 E 1ST AVE STE 102
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-3786
Country : US
Telephone Number : 303-464-8440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2012
Last Update Date : 08/03/2020

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