Provider Demographics
NPI:1598207169
Name:TILLITT, SHELIA (LPN)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:TILLITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MCHINES PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-1953
Mailing Address - Country:US
Mailing Address - Phone:919-981-0790
Mailing Address - Fax:919-981-0135
Practice Address - Street 1:5800 MCHINES PL
Practice Address - Street 2:SUITE 120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1953
Practice Address - Country:US
Practice Address - Phone:919-981-0790
Practice Address - Fax:919-981-0135
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77990164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1043225907Medicaid