Provider Demographics
NPI:1053007393
Name:TILDEN, ANGELA FRANCINE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:FRANCINE
Last Name:TILDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:FRANCINE
Other - Last Name:HENSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30767 KENADY LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9755
Mailing Address - Country:US
Mailing Address - Phone:541-517-1383
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-3659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95154615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse