Provider Demographics
NPI:1417168261
Name:TILLER, KATHERINE EMMA I (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:EMMA
Last Name:TILLER
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63360 NW BRITTA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9475
Mailing Address - Country:US
Mailing Address - Phone:541-318-4845
Mailing Address - Fax:
Practice Address - Street 1:63360 NW BRITTA ST STE 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9475
Practice Address - Country:US
Practice Address - Phone:541-318-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent