Provider Demographics
NPI:1407113152
Name:FILLIE, SIA KATHERINE
Entity Type:Individual
Prefix:MS
First Name:SIA
Middle Name:KATHERINE
Last Name:FILLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W SHARPNACK ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-4033
Mailing Address - Country:US
Mailing Address - Phone:267-736-3800
Mailing Address - Fax:
Practice Address - Street 1:2146 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-3905
Practice Address - Country:US
Practice Address - Phone:267-519-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN269566164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse