Provider Demographics
NPI:1497992499
Name:REILLY, CLAIRE MARGARET (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARGARET
Last Name:REILLY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 SE 12TH PL
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9397
Mailing Address - Country:US
Mailing Address - Phone:503-861-6240
Mailing Address - Fax:503-861-6358
Practice Address - Street 1:2185 SE 12TH PL
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9311
Practice Address - Country:US
Practice Address - Phone:503-861-6240
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MO2020011504363A00000X
WA60392744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant