Basic Information
| Provider Information | |||||||||
| NPI: | 1467763813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TILSON | ||||||||
| FirstName: | MATHEW | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2018 N 114TH ST | ||||||||
| Address2: | |||||||||
| City: | WAUWATOSA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532262214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148395795 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2741 W LAYTON AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146728050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 172644-030 | WI | N | Nursing Service Providers | Registered Nurse | 363L00000X | 10069 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.