Provider Demographics
NPI:1598785040
Name:SCHILD, ROSEMARIE CECELIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:CECELIA
Last Name:SCHILD
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 1:1619 SE FLAVEL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6033
Mailing Address - Country:US
Mailing Address - Phone:503-235-6587
Mailing Address - Fax:
Practice Address - Street 1:2816 SE STEELE ST STE 8
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4525
Practice Address - Country:US
Practice Address - Phone:503-236-2303
Practice Address - Fax:503-236-2614
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP49202Medicare UPIN