Healthcare Provider Details

I. General information

NPI: 1831063536
Provider Name (Legal Business Name): LYDIA TILLMAAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-4231
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number264872
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP.AP.70142977-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: