Healthcare Provider Details

I. General information

NPI: 1841910536
Provider Name (Legal Business Name): TIFFANY ABBEY ARENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

834 W MONROE ST APT 513
CHICAGO IL
60607-2971
US

V. Phone/Fax

Practice location:
  • Phone: 630-803-4455
  • Fax:
Mailing address:
  • Phone: 630-803-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.025847
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number209.025847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: