Provider Demographics
NPI:1457304073
Name:TILSON, CATHERINE C (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:C
Last Name:TILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-4167
Mailing Address - Country:US
Mailing Address - Phone:276-642-7335
Mailing Address - Fax:276-642-7347
Practice Address - Street 1:205 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-4167
Practice Address - Country:US
Practice Address - Phone:276-642-7335
Practice Address - Fax:276-642-7347
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001074652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
00V648C68Medicare ID - Type Unspecified