Provider Demographics
NPI:1073099735
Name:TILLEY, BOBBI MAE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:BOBBI
Middle Name:MAE
Last Name:TILLEY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:GODDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16214 SE EVERGREEN HWY
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9223
Mailing Address - Country:US
Mailing Address - Phone:360-771-5836
Mailing Address - Fax:
Practice Address - Street 1:16214 SE EVERGREEN HWY
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9223
Practice Address - Country:US
Practice Address - Phone:360-771-5836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60079814163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse