Healthcare Provider Details

I. General information

NPI: 1023927027
Provider Name (Legal Business Name): WENDY TILLMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 JOHNSON RD
GOLDEN CO
80401-6002
US

IV. Provider business mailing address

8415 LAMAR DR
ARVADA CO
80003-1356
US

V. Phone/Fax

Practice location:
  • Phone: 720-723-5114
  • Fax:
Mailing address:
  • Phone: 303-898-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN0187398
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: