Provider Demographics
NPI:1942550272
Name:SPILLER, NATALIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:SPILLER
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 1:220 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3150
Mailing Address - Country:US
Mailing Address - Phone:618-942-3344
Mailing Address - Fax:618-942-5045
Practice Address - Street 1:220 N PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3150
Practice Address - Country:US
Practice Address - Phone:618-942-3344
Practice Address - Fax:618-942-5045
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant