Provider Demographics
NPI:1780766329
Name:SCHILLAR, PAMELLA (CRNA)
Entity type:Individual
Prefix:
First Name:PAMELLA
Middle Name:
Last Name:SCHILLAR
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:PAMELLA
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 2338
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0911
Mailing Address - Country:US
Mailing Address - Phone:208-946-0829
Mailing Address - Fax:
Practice Address - Street 1:7436 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-9338
Practice Address - Country:US
Practice Address - Phone:480-325-9600
Practice Address - Fax:480-493-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-34636367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807239400Medicaid