Provider Demographics
NPI:1104811033
Name:SCHILLING, SANDRA LEIGH (ARNP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEIGH
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:LEIGH
Other - Last Name:FORSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2614 E 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4541
Mailing Address - Country:US
Mailing Address - Phone:509-993-7192
Mailing Address - Fax:
Practice Address - Street 1:123 W CASCADE WAY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6017
Practice Address - Country:US
Practice Address - Phone:509-489-4581
Practice Address - Fax:509-482-0717
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005168207Q00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624321Medicaid
WA1104811033Medicaid
S83777Medicare UPIN
WI501895Medicare Oscar/Certification