Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD.203734 | LA |
NPI | 1134448814 |
---|---|
Provider Name | Cea Chenea Tillis |
First Address | Metairie, LA 70001-3036 |
Second Address | Metairie, LA 70001-3036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2010 |
Last Update Date | 20/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09185577 | (05) | LA |
2120051 | (05) | LA |