Healthcare Provider Details

I. General information

NPI: 1730132713
Provider Name (Legal Business Name): LILIYA V. BILAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22000 MARINE VIEW DR S SUITE 100
DES MOINES WA
98198-6233
US

IV. Provider business mailing address

22000 MARINE VIEW DR S STE 100
DES MOINES WA
98198-6233
US

V. Phone/Fax

Practice location:
  • Phone: 206-870-4460
  • Fax: 206-870-4770
Mailing address:
  • Phone: 206-870-4460
  • Fax: 253-351-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10004046
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004046
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: