Provider Demographics
NPI:1669719159
Name:TILL, KRISTI DARIA
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:DARIA
Last Name:TILL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:DARIA
Other - Last Name:TILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-0432
Mailing Address - Country:US
Mailing Address - Phone:541-935-0408
Mailing Address - Fax:541-935-6270
Practice Address - Street 1:1015 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3113
Practice Address - Country:US
Practice Address - Phone:541-935-0408
Practice Address - Fax:541-935-6270
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096003255RN163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management