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General NPI Number Information
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NPI Number | 1770670473
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Entity Type | Individual
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Provider Name | NATHAN TILLOTSON
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 315 E ELM ST STE 310
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City | CALDWELL
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State | ID
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Zip | 83605-4881
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Country | US
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Telephone | 208-454-2035
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Fax | 208-454-1065
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Provider Business Mailing Address
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Address Line | PO BOX 742941
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City | ATLANTA
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State | GA
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Zip | 30374-2941
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 02426
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 0546950
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License Number State | KS
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