Provider Demographics
NPI:1093182479
Name:LILLY, ALANNA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALANNA
Middle Name:ELIZABETH
Last Name:LILLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5960
Mailing Address - Country:US
Mailing Address - Phone:208-606-0396
Mailing Address - Fax:208-936-7002
Practice Address - Street 1:824 S DIAMOND ST
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-5960
Practice Address - Country:US
Practice Address - Phone:208-606-0396
Practice Address - Fax:208-936-7002
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID-1253363A00000X
IDPA-1253363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant