Provider Demographics
NPI:1952511537
Name:SCHILLO, MARY ANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:SCHILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-3450
Mailing Address - Country:US
Mailing Address - Phone:928-283-5565
Mailing Address - Fax:
Practice Address - Street 1:167 N. MAIN ST.
Practice Address - Street 2:TCRHCC
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN117065163W00000X, 163WI0500X, 163WW0000X
AZRN17065163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care