Provider Demographics
NPI:1639255722
Name:TILLETT, LUCY ANNE (RN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:LUCY ANNE
Middle Name:
Last Name:TILLETT
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 NE DUNCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-1644
Mailing Address - Country:US
Mailing Address - Phone:503-869-1627
Mailing Address - Fax:503-488-5852
Practice Address - Street 1:2724 NE DUNCKLEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-1644
Practice Address - Country:US
Practice Address - Phone:503-869-1627
Practice Address - Fax:503-488-5852
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health