Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 10113722 | OR |
NPI | 1073693115 |
---|---|
Provider Name | Mrs. Lynette Tilley |
First Address | Hood River, OR 97031-8671 |
Second Address | Hood River, OR 97031-8671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |