Provider Demographics
NPI:1194174730
Name:KOLILIS, DAN LOUIS (RN)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:LOUIS
Last Name:KOLILIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47754 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:OR
Mailing Address - Zip Code:97833-6403
Mailing Address - Country:US
Mailing Address - Phone:541-403-4863
Mailing Address - Fax:
Practice Address - Street 1:47754 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:OR
Practice Address - Zip Code:97833-6403
Practice Address - Country:US
Practice Address - Phone:541-403-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-04
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201141129RN163WH0200X
IDN-35484163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health