Provider Demographics
NPI:1467763813
Name:TILSON, MATHEW ANDREW (APNP)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:ANDREW
Last Name:TILSON
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 N 114TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2214
Mailing Address - Country:US
Mailing Address - Phone:414-839-5795
Mailing Address - Fax:
Practice Address - Street 1:2741 W LAYTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2600
Practice Address - Country:US
Practice Address - Phone:414-672-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172644-030163W00000X
WI10069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse