Provider Demographics
NPI:1497471270
Name:TILLMAN, BYRON (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 YALE BLVD SE STE 2220
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4383
Mailing Address - Country:US
Mailing Address - Phone:505-272-4327
Mailing Address - Fax:505-272-7232
Practice Address - Street 1:2600 YALE BLVD SE STE 2220
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4383
Practice Address - Country:US
Practice Address - Phone:505-272-4327
Practice Address - Fax:505-272-7232
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR49484163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty