Basic Information
Provider Information
NPI: 1922568708
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHILLER
FirstName: ERIKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MS, RD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3947 E PARKCENTER BLVD
Address2:  
City: BOISE
State: ID
PostalCode: 837164739
CountryCode: US
TelephoneNumber: 9137026920
FaxNumber:  
Practice Location
Address1: 190 E BANNOCK ST
Address2:  
City: BOISE
State: ID
PostalCode: 837126241
CountryCode: US
TelephoneNumber: 2083812222
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/20/2019
LastUpdateDate: 03/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133V00000XD-1091IDY Dietary & Nutritional Service ProvidersDietitian, Registered 

No ID Information.


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