Provider Demographics
NPI:1144544800
Name:TILTON, PENELYN DARCIE (RN)
Entity type:Individual
Prefix:
First Name:PENELYN
Middle Name:DARCIE
Last Name:TILTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26176 396TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:SD
Mailing Address - Zip Code:57363-5609
Mailing Address - Country:US
Mailing Address - Phone:605-999-6659
Mailing Address - Fax:
Practice Address - Street 1:26176 396TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:SD
Practice Address - Zip Code:57363-5609
Practice Address - Country:US
Practice Address - Phone:605-999-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD-RN R036156163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health