Basic Information
| Provider Information | |||||||||
| NPI: | 1497992499 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REILLY | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2185 SE 12TH PL | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038616240 | ||||||||
| FaxNumber: | 5038616358 | ||||||||
| Practice Location | |||||||||
| Address1: | 2185 SE 12TH PL | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038616240 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2009 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 2020011504 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 60392744 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.