Healthcare Provider Details

I. General information

NPI: 1639446339
Provider Name (Legal Business Name): TIFFINI DAWN YOUNG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFINI DAWN STOROR/SCHABACKER

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 G RD SUITE 240
GRAND JUNCTION CO
81505-1002
US

IV. Provider business mailing address

PO BOX 1687
GRAND JUNCTION CO
81502-1687
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-7908
  • Fax: 970-245-0656
Mailing address:
  • Phone: 970-256-6322
  • Fax: 970-263-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM170021
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: