Healthcare Provider Details

I. General information

NPI: 1467230524
Provider Name (Legal Business Name): AQUEELAH TILLMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 524
BERKELEY CA
94705-2120
US

IV. Provider business mailing address

2999 REGENT ST STE 524
BERKELEY CA
94705-2120
US

V. Phone/Fax

Practice location:
  • Phone: 510-495-0310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236378
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW236378
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: