Individual
MUSHINA TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19358 N LOUSANDRA DR, MARICOPA, AZ 85138-5776
(708) 264-8280
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
8863183
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8863183
THERAPEUTIC FOSTER CARE
AZ
Enumeration date
07/22/2019
Last updated
07/22/2019
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