Provider Demographics
NPI:1487042420
Name:ANGELA SCHILLING-KOONS, NP, LLC
Entity type:Organization
Organization Name:ANGELA SCHILLING-KOONS, NP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHILLING-KOONS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-202-7882
Mailing Address - Street 1:203 S CANDY LN
Mailing Address - Street 2:BLDG 13AB
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-649-1389
Mailing Address - Fax:928-634-5314
Practice Address - Street 1:203 S CANDY LN
Practice Address - Street 2:BLDG 13AB
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-649-1389
Practice Address - Fax:928-634-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ026196Medicaid
AZ026196Medicaid