Provider Demographics
NPI:1902992100
Name:SCHILLE, TAMERA
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:SCHILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WALLACE WAY
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-8805
Mailing Address - Country:US
Mailing Address - Phone:509-882-3444
Mailing Address - Fax:509-882-1097
Practice Address - Street 1:1000 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-8805
Practice Address - Country:US
Practice Address - Phone:509-882-3444
Practice Address - Fax:509-882-1097
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
22551OtherGROUP HEALTH
WA128893OtherL & I
SC2442OtherREGENCE
WA8174856Medicaid
911019392OtherCOMMERCIAL
SC2442OtherREGENCE
911019392OtherCOMMERCIAL
GAB16266Medicare ID - Type Unspecified