Provider Demographics
NPI:1700308053
Name:WARREN, SKILIER CULLERS (LMP)
Entity Type:Individual
Prefix:
First Name:SKILIER
Middle Name:CULLERS
Last Name:WARREN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N 198TH ST UNIT H301
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3682
Mailing Address - Country:US
Mailing Address - Phone:360-319-3010
Mailing Address - Fax:
Practice Address - Street 1:20124 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-1117
Practice Address - Country:US
Practice Address - Phone:206-366-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60722226225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist