Lillywyte Llc

NPI 1013194380 - Physician Assistant - 363AS0400X

NPI Details
NPI 1013194380
Enumeration Date 01/29/2008
Last Updated 06/17/2010
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name SHELLY SHELLY
Position REPRESENTATIVE
Phone (281) 462-1285
Fax (281) 462-1554
Practice Location
8418 COLONIAL DR
LONE TREE CO, 80124-9738, US
Phone (281) 462-1285
Fax (281) 462-1554
Business Location
PO BOX 1288
CROSBY TX, 77532-1288, US
Phone (281) 462-1285
Fax (281) 462-1554
Toxanomy
Taxonomy Code 363AS0400X
License State Colorado
License Number 2612
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According to our database, Lillywyte Llc NPI is 1013194380, taxonomy code is 363AS0400X and license number is 2612, license state is located at Colorado. Lillywyte Llc physically located at 8418 Colonial Dr, Lone Tree CO, 80124-9738. NPI Number 1033115704 has the healthcare provider type.

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1013194380 NPI number is provided on an as is basis without warranty of any kind. 1013194380 is maintained by the National Plan & Provider Enumeration System. The contents of Lillywyte Llc are for informational purposes only.