MEDICARE: TIFFANY ANN FREELON RN

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
1	163W00000X	Registered Nurse	2006007589	MO

General Provider Information

NPI Number	:	1386809382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ANN FREELON RN

Provider Business Mailing Address
First Line	:	10500 E 46TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-3841
Country	:	US
Telephone Number	:	816-214-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	10500 E 46TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-3841
Country	:	US
Telephone Number	:	816-214-6987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2008
Last Update Date	:	07/20/2008

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