Tilly, Jane B

Tilly, Jane B is an sole proprietor health care provider with primary practice located at 770 Pennsylvania Ave , West Bend WI 53095-4142. She recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as her primary health care specialty. Tilly, Jane B can be contacted via phone (262) 339-4752.

Contact Information

Primary practice address
770 Pennsylvania Ave West Bend WI 53095-4142
Phone: (262) 339-4752
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 78518-030 Wisconsin

Profile Details

NPI number 1609827690
LBN Legal business name Tilly, Jane B
Credentials Registered Nurse (RN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 13th, 2006
Last updated Feb 23rd, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609827690 NPPES
Wisconsin MEDICAID 39930300

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