Provider Demographics
NPI:1073693115
Name:TILLEY, LYNETTE (CPM,LDM)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:TILLEY
Suffix:
Gender:F
Credentials:CPM,LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 FREEDOM DR
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-8671
Mailing Address - Country:US
Mailing Address - Phone:541-490-3140
Mailing Address - Fax:541-386-8365
Practice Address - Street 1:2324 FREEDOM DR
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-8671
Practice Address - Country:US
Practice Address - Phone:541-490-3140
Practice Address - Fax:541-386-8365
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10113722176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife