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:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-6330
Mailing Address - Fax:208-367-4765
Practice Address - Street 1:875 S VANGUARD WAY STE 200
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8542
Practice Address - Country:US
Practice Address - Phone:208-468-5910
Practice Address - Fax:208-463-3356
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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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