Healthcare Provider Details

I. General information

NPI: 1356495725
Provider Name (Legal Business Name): KIMBERLY JANE ROSS-TILLEY MSN, RN, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 RIVER RD
DOVER DE
19901-3753
US

IV. Provider business mailing address

1041 IRISH HILL RD
FELTON DE
19943-5449
US

V. Phone/Fax

Practice location:
  • Phone: 302-739-4728
  • Fax:
Mailing address:
  • Phone: 302-284-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberL1-0016309
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: