Provider Demographics
NPI:1912197815
Name:SHILLING, DELLARIE L (FNP)
Entity Type:Individual
Prefix:
First Name:DELLARIE
Middle Name:L
Last Name:SHILLING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0851
Mailing Address - Country:US
Mailing Address - Phone:912-871-6206
Mailing Address - Fax:912-681-8558
Practice Address - Street 1:1310 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0851
Practice Address - Country:US
Practice Address - Phone:912-871-6206
Practice Address - Fax:912-681-8558
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069911NP363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN069911NPOtherLICENSE
GA000802084AMedicaid