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

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: September 13, 2026.

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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Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CATHERINE ANN LUSK PTA
Physical Therapy Assistant
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-6626
AMY ROSE DOHERTY
Speech-Language Pathologist
326 CHARDONNAY AVE, SUITE 1
PROSSER, WA 99350
Benton County (509) 786-6626
EVAN MALCOM
Speech-Language Pathologist
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-2222
MRS. EMIGH ROUSE CLINICAL FELLOW, SLP
Speech-Language Pathologist
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-6626
LATHEN CARLSON PTA
Physical Therapy Assistant
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-6626
COY M NEVILLE PTA
Physical Therapy Assistant
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (435) 216-6363
CORTNEY JEAN WHITE
Speech-Language Pathologist
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-6626
ANGELA DANESE LENHART
Physical Therapist
326 CHARDONNAY AVE
PROSSER, WA 99350
Benton County (509) 786-6626

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Idalis Licea's NPI number?

The NPI number for Idalis Licea is 1407789001. It was assigned to this individual provider in the NPPES registry on June 4, 2026.

Where is Idalis Licea located?

Idalis Licea practices at 326 Chardonnay Ave, Prosser, WA 99350. The listed phone number is (509) 786-1576.

What is Idalis Licea's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Ambulatory Care, with taxonomy code 163WP2201X.

When was this NPI record last updated?

The NPPES record for Idalis Licea was last updated on June 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.