Provider Demographics
NPI:1912469198
Name:CASILLAS, ANNA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 FIR LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2535
Mailing Address - Country:US
Mailing Address - Phone:064-792-5444
Mailing Address - Fax:
Practice Address - Street 1:2021 E COLLEGE WAY STE 210
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2373
Practice Address - Country:US
Practice Address - Phone:360-755-3670
Practice Address - Fax:360-873-8697
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60942913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine