Individual
VICKIE B TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
1400 N 500 E, LOGAN, UT 84341-2455
(435) 716-1000
(435) 716-5420
Mailing address
1400 N 500 E, LOGAN, UT 84341-2455
(435) 716-1000
(435) 716-5420
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
188921-3102
UT
Other
Enumeration date
02/22/2010
Last updated
02/22/2010
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