Individual
MONIQUE TAKEISHA TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD STE 240, PLYMOUTH MEETING, PA 19462-2225
(800) 879-4471
(610) 825-1604
Mailing address
4222 RED HAVEN RD, PIKESVILLE, MD 21208-5853
(410) 484-7106
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R164341
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R164341
RN LICENSE
MD
Enumeration date
05/08/2011
Last updated
05/08/2011
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