Healthcare Provider Details

I. General information

NPI: 1982935169
Provider Name (Legal Business Name): LAURA COOKMAN TILLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

9040 FITZSIMMONS DR
TACOMA WA
98431-1000
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-3000
  • Fax:
Mailing address:
  • Phone: 253-968-2997
  • Fax: 253-968-2550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60485644
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD210012109
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: