Healthcare Provider Details

I. General information

NPI: 1275315541
Provider Name (Legal Business Name): WHITNEY LEE TILLER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15760 NW OVERTON DR
BEAVERTON OR
97006-5367
US

IV. Provider business mailing address

15760 NW OVERTON DR
BEAVERTON OR
97006-5367
US

V. Phone/Fax

Practice location:
  • Phone: 971-500-4771
  • Fax:
Mailing address:
  • Phone: 971-500-4771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberLC-LC-10235545
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10059227
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: