Individual
CHEYENNE SUMMER LILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, LAT, ATC, NREMT
Contact information
Practice address
6165 W EMERALD ST, BOISE, ID 83704-8613
(208) 302-3900
Mailing address
33 E IDAHO AVE UNIT 319B, MERIDIAN, ID 83642-1144
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/20/2024
Last updated
09/11/2025
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