Provider Demographics
NPI:1457559106
Name:TILSON, CONNIE SUE (RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:TILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S WYNN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-2529
Mailing Address - Country:US
Mailing Address - Phone:419-724-2289
Mailing Address - Fax:
Practice Address - Street 1:51 S WYNN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-2529
Practice Address - Country:US
Practice Address - Phone:419-724-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR.N. 373385163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse