Provider Demographics
NPI:1366216715
Name:SCHILLACI, MERCEDES MARIE
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIE
Last Name:SCHILLACI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1303
Mailing Address - Country:US
Mailing Address - Phone:740-968-7006
Mailing Address - Fax:740-968-7256
Practice Address - Street 1:4697 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1303
Practice Address - Country:US
Practice Address - Phone:740-968-7006
Practice Address - Fax:740-968-7256
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176978.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse