Individual
MS. MYRA M. TILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5457 TWIN KNOLLS RD STE 300, COLUMBIA, MD 21045-3296
(410) 861-0740
(434) 225-9723
Mailing address
5457 TWIN KNOLLS RD STE 300, COLUMBIA, MD 21045-3296
(410) 861-0740
(434) 225-9723
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R212286
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AC005810
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
072673700
—
MD
Enumeration date
03/25/2013
Last updated
10/15/2024
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