Tisdale, Mary

Tisdale, Mary is an individual health care provider with primary practice located at 1001 Main St Ste 300 , Peoria IL 61606-2036. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife. Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife is her primary health care specialty. Tisdale, Mary can be contacted via phone (309) 495-0200.

Contact Information

Primary practice address
1001 Main St Ste 300 Peoria IL 61606-2036
Phone: (309) 495-0200
Fax: (309) 676-6545
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209008217 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X APRN11000699 Florida
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 209007925 Illinois

Profile Details

NPI number 1992034532
LBN Legal business name Tisdale, Mary
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 10th, 2009
Last updated Apr 5th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992034532 NPPES
Illinois MEDICAID 9337001

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