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NPI Code Detail

MEDICARE: MRS. KATHERINE EMMA TILLER I R.N.

MEDICARE: MRS. KATHERINE EMMA TILLER I R.N.
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
1163WP0807XChild & Adolescent Psychiatric/Mental Health Registered NurseOR

General Provider Information

NPI Number : 1417168261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHERINE EMMA TILLER I R.N.
Provider Business Mailing Address
First Line : 63360 NW BRITTA ST STE 1
Second Line :
City : BEND
State : OR
Zip : 97701-9475
Country : US
Telephone Number : 541-318-4845
Fax Number :
Provider Business Practice Location Address
First Line : 63360 NW BRITTA ST STE 1
Second Line :
City : BEND
State : OR
Zip : 97701-9475
Country : US
Telephone Number : 541-318-4845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. KATHERINE EMMA TILLER I R.N.” Practice Location

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