Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 153992 | MA |
NPI | 1083769913 |
---|---|
Provider Name | Valerie Tillman |
First Address | Falmouth, MA 02541 |
Second Address | Falmouth, MA 02540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0384551 | (05) | MA |
50240 | HARVARD PILGRIM (01) | MA |
CN0258 | BLUE CROSS (01) | MA |
S52640 | (02) |