IDALIS AMADALEY LICEA
NPI 1407789001
Registered Nurse - Ambulatory Care in Prosser, WA

Q: What is the provider's specialty?

The provider's specialty is Registered Nurse with taxonomy code 163WP2201X and a focus in Ambulatory Care.

Active since June 04, 2026

326 CHARDONNAY AVE, PROSSER, WA 99350(509) 786-1576 Get Directions Write a Review

NPPES record last updated: June 4, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Idalis Amadaley Licea NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDALIS AMADALEY LICEA (NPI 1407789001) is an individual ambulatory care provider in Prosser, Washington, licensed in Washington (61382393) and active in the NPI registry since June 2026.

NPPES Registry Identity

NPI1407789001

Entity TypeIndividualFemale

Primary Taxonomy163WP2201X

Provider Legal NameIDALIS AMADALEY LICEA

Location Address326 CHARDONNAY AVEProsser, WA 99350-9515

Mailing Address1611 Diamond AveGrandview, WA 98930-6118 · (509) 786-1576

Phone(509) 786-1576

Sole ProprietorNo

Enumeration DateJune 4, 2026

NPPES CertifiedJune 4, 2026

✔ NPI 1407789001 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered Nurse · Ambulatory CareNursing Service Providers

Taxonomy Code163WP2201X

License✔ Licensed in WA · 61382393

326 CHARDONNAY AVE, Prosser, WA 99350

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