MEDICARE: MRS. TIFFANY BOND CPNP

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	363LP0200X	Pediatric Nurse Practitioner	2003015716	MO

General Provider Information

NPI Number	:	1528011699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY BOND CPNP

Provider Business Mailing Address
First Line	:	26602 STATE HIGHWAY T
Second Line	:
City	:	EXCELLO
State	:	MO
Zip	:	65247-2162
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N MORLEY ST
Second Line	:	SUITE NUMBER 105
City	:	MOBERLY
State	:	MO
Zip	:	65270-2556
Country	:	US
Telephone Number	:	660-263-5787
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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