| Organization Name: | LILLYWYTE LLC |
| NPI Number: | 1013194380 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHELLY JATANA (REPRESENTATIVE) |
| Mailing Address: | 8418 Colonial Dr Lone Tree |
| State: | CO US |
| Postal Code: | 801249738 |
| Phone Number: | 2814621285 |
| Fax Number: | 2814621554 |
| NPI Enumeration Date: | 01/29/2008 |
| NPI Last Update Date: | 06/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 2612 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |