Provider Demographics
NPI:1700328341
Name:ITUEN, LILLY
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:ITUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-3561
Mailing Address - Country:US
Mailing Address - Phone:214-929-6656
Mailing Address - Fax:
Practice Address - Street 1:1524 AUDREY DR
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3561
Practice Address - Country:US
Practice Address - Phone:214-929-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based