Provider Demographics
NPI:1942741343
Name:TILLEY, REBECCA (RNFA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TILLEY
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SUNSET DR
Mailing Address - Street 2:PO BOX 3290
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1387
Mailing Address - Country:US
Mailing Address - Phone:541-963-8421
Mailing Address - Fax:541-963-1837
Practice Address - Street 1:900 SUNSET DR
Practice Address - Street 2:900 SUNSET DRIVE
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1387
Practice Address - Country:US
Practice Address - Phone:541-963-8421
Practice Address - Fax:541-963-1837
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079011108RN282N00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No282N00000XHospitalsGeneral Acute Care Hospital