MEDICARE: RASHEEDA TILLMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	565107	PA

General Provider Information

NPI Number	:	1063841716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHEEDA TILLMAN

Provider Business Mailing Address
First Line	:	4803 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4433
Country	:	US
Telephone Number	:	215-326-9491
Fax Number	:

Provider Business Practice Location Address
First Line	:	4803 WOODLAND AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-4433
Country	:	US
Telephone Number	:	215-326-9491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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