Organization
LILLYWYTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY JATANA (REPRESENTATIVE)
(303) 944-4085
Entity
Organization
Contact information
Practice address
8418 COLONIAL DR, LONE TREE, CO 80124-9738
(281) 462-1285
(281) 462-1554
Mailing address
PO BOX 1288, CROSBY, TX 77532-1288
(281) 462-1285
(281) 462-1554
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2612
CO
Other
Enumeration date
01/29/2008
Last updated
06/17/2010
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