Basic Information
| Provider Information | |||||||||
| NPI: | 1942741343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TILLEY | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 SUNSET DR | ||||||||
| Address2: | PO BOX 3290 | ||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978501387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419638421 | ||||||||
| FaxNumber: | 5419631837 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 SUNSET DR | ||||||||
| Address2: | 900 SUNSET DRIVE | ||||||||
| City: | LA GRANDE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 978501387 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419638421 | ||||||||
| FaxNumber: | 5419631837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2017 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 079011108RN | OR | N | Hospitals | General Acute Care Hospital | 163WR0006X | 079011108RN | OR | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
No ID Information.