Provider Demographics
NPI:1366285041
Name:TILAND, MCKENNA (CD)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:TILAND
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ETRURIA ST APT 12
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1609
Mailing Address - Country:US
Mailing Address - Phone:360-631-4483
Mailing Address - Fax:
Practice Address - Street 1:11 ETRURIA ST APT 12
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1609
Practice Address - Country:US
Practice Address - Phone:360-631-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula