Basic Information
Provider Information
NPI: 1477102960
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHILLING
FirstName: RAILI
MiddleName: LARSSON
NamePrefix:  
NameSuffix:  
Credential: CAA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 DEER TRAIL RD
Address2:  
City: BOULDER
State: CO
PostalCode: 803029422
CountryCode: US
TelephoneNumber: 3032503312
FaxNumber:  
Practice Location
Address1: 2211 LOMAS BLVD NE # 106000
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871062719
CountryCode: US
TelephoneNumber: 5052722610
FaxNumber: 5052721300
Other Information
ProviderEnumerationDate: 09/06/2019
LastUpdateDate: 10/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X  N Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 
367H00000XAA2019-005NMY Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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