1427238252 NPI number — MS. VICKI LYNN TILTON COSMETIC TECHNICIAN

Table of content: MS. VICKI LYNN TILTON COSMETIC TECHNICIAN (NPI 1427238252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427238252 NPI number — MS. VICKI LYNN TILTON COSMETIC TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILTON
Provider First Name:
VICKI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
COSMETIC TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427238252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W MONROE ST
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
BLOOMINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61701-3997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-242-4951
Provider Business Mailing Address Fax Number:
309-827-5382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 W MONROE ST
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61701-3997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-242-4951
Provider Business Practice Location Address Fax Number:
309-827-5382
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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