MEDICARE: ANNA MARIE CASILLAS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	AP60942913	WA

General Provider Information

NPI Number	:	1912469198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MARIE CASILLAS ARNP

Provider Business Mailing Address
First Line	:	1317 FIR LN
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2535
Country	:	US
Telephone Number	:	64-792-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 E COLLEGE WAY STE 210
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2373
Country	:	US
Telephone Number	:	360-755-3670
Fax Number	:	360-873-8697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2019
Last Update Date	:	11/08/2023

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