Provider Demographics
NPI:1194739003
Name:TILLEY, ERINN (NP)
Entity type:Individual
Prefix:MS
First Name:ERINN
Middle Name:
Last Name:TILLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ERINN
Other - Middle Name:T
Other - Last Name:STUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY CLINIC
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8480
Mailing Address - Fax:781-744-3443
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY CLINIC
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8480
Practice Address - Fax:781-744-3443
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110770363LA2100X
MA284976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110086084AMedicaid
MA001664701Medicare PIN