Healthcare Provider Details

I. General information

NPI: 1356863039
Provider Name (Legal Business Name): TIFFANY MARIE KUEHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2152 S VINEYARD STE 138
MESA AZ
85210-6882
US

IV. Provider business mailing address

727 N BERMUDA
MESA AZ
85205-6116
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-6646
  • Fax:
Mailing address:
  • Phone: 480-255-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN195117
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN195117
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN195117
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberRN195117
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN195117
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN195117
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN195117
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-02767
License Number StateAZ
# 9
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN195117
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: