Provider Demographics
NPI:1386730844
Name:SCHILLIOS, MARC (MSN, FNP)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:SCHILLIOS
Suffix:
Gender:M
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-2395
Mailing Address - Fax:509-865-0757
Practice Address - Street 1:120 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2358
Practice Address - Country:US
Practice Address - Phone:509-326-4343
Practice Address - Fax:509-329-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8941744OtherMEDICARE
WA1386730844Medicaid
WAVAD0000Medicare UPIN