Healthcare Provider Details

I. General information

NPI: 1285789040
Provider Name (Legal Business Name): TIFFANY J WEBER CRNA, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

4211 W AVENIDA DEL REY
PHOENIX AZ
85083-2400
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-5020
  • Fax:
Mailing address:
  • Phone: 920-252-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number125313-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: