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NPI Code Detail

MEDICARE: TIFFANY STAPLES

MEDICARE: TIFFANY STAPLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0200XCritical Care Medicine Registered Nurse427073OH

General Provider Information

NPI Number : 1306360904
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY STAPLES
Provider Business Mailing Address
First Line : 3772 GRANT AVE APT B
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45431-2150
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 122 WYOMING ST
Second Line :
City : DAYTON
State : OH
Zip : 45409-2731
Country : US
Telephone Number : 937-223-4661
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2017
Last Update Date : 07/26/2017

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1164421632 — STEPHEN CHARLES SCHRECK MD
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Directions to “ TIFFANY STAPLES ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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