Healthcare Provider Details

I. General information

NPI: 1417168261
Provider Name (Legal Business Name): KATHERINE EMMA TILLER I R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63360 NW BRITTA ST STE 1
BEND OR
97701-9475
US

IV. Provider business mailing address

63360 NW BRITTA ST STE 1
BEND OR
97701-9475
US

V. Phone/Fax

Practice location:
  • Phone: 541-318-4845
  • Fax:
Mailing address:
  • Phone: 541-318-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: