Individual
MARY TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209008217
IL
367A00000X
Advanced Practice Midwife
Primary
209007925
IL
367A00000X
Advanced Practice Midwife
APRN11000699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9337001
—
IL
Enumeration date
12/10/2009
Last updated
04/05/2021
Update your record
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