Provider Demographics
NPI:1528189578
Name:MCCLELLAN-TILSON, BRENDA JO (APNP, MSN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JO
Last Name:MCCLELLAN-TILSON
Suffix:
Gender:F
Credentials:APNP, MSN
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Other - Last Name:
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Mailing Address - Street 1:302 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-5904
Mailing Address - Country:US
Mailing Address - Phone:715-423-9610
Mailing Address - Fax:715-423-7753
Practice Address - Street 1:1355 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5265
Practice Address - Country:US
Practice Address - Phone:715-423-9610
Practice Address - Fax:715-423-7753
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI75722-030163W00000X
WI789-33363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse