Individual
DIBA TILLERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
301 BRUSHY CREEK RD STE 106, CEDAR PARK, TX 78613-3151
(512) 765-9599
Mailing address
9311 N FM 620 RD # 247, AUSTIN, TX 78726-4129
(512) 765-9959
(888) 227-7057
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
664335
TX
163WL0100X
Lactation Consultant (Registered Nurse)
L-36079
TX
Other
Enumeration date
02/16/2017
Last updated
03/26/2021
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