Provider Demographics
NPI:1730132713
Name:BILAN, LILIYA V (PA-C)
Entity Type:Individual
Prefix:
First Name:LILIYA
Middle Name:V
Last Name:BILAN
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 1:22000 MARINE VIEW DR S STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6233
Mailing Address - Country:US
Mailing Address - Phone:206-870-4460
Mailing Address - Fax:253-351-5399
Practice Address - Street 1:22000 MARINE VIEW DR S
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-870-4460
Practice Address - Fax:206-870-4770
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004046363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0310531OtherSTATE L&I
WA1037638Medicaid
WAG8924609Medicare PIN