Provider Demographics
NPI:1619219912
Name:TILSON, MYRA M (NP)
Entity Type:Individual
Prefix:MS
First Name:MYRA
Middle Name:M
Last Name:TILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MYRA
Other - Middle Name:M
Other - Last Name:PIERSON-BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11002 VEIRS MILL ROAD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5922
Mailing Address - Country:US
Mailing Address - Phone:301-962-6173
Mailing Address - Fax:301-962-5733
Practice Address - Street 1:11002 VEIRS MILL ROAD
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5922
Practice Address - Country:US
Practice Address - Phone:301-962-6173
Practice Address - Fax:301-962-5733
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130061000Medicaid