Provider Demographics
NPI:1366782252
Name:TILP, VANESSA BROOK (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:BROOK
Last Name:TILP
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:BROOK
Other - Last Name:AUDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UCLA OBGYN CONSULTATION SUITE
Mailing Address - Street 2:200 UCLA MEDICAL PLAZA SUITE 430
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-794-4434
Mailing Address - Fax:
Practice Address - Street 1:UCLA OBGYN CONSULTATION SUITE
Practice Address - Street 2:200 UCLA MEDICAL PLAZA SUITE 430
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637262163W00000X
CA1648176B00000X
CA15443363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health