Healthcare Provider Details

I. General information

NPI: 1902801293
Provider Name (Legal Business Name): TIFFANY ATHEY MSN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 300
CHICAGO IL
60602-4495
US

IV. Provider business mailing address

PO BOX 1008
NORTHBROOK IL
60065-1008
US

V. Phone/Fax

Practice location:
  • Phone: 312-558-6481
  • Fax: 312-762-3919
Mailing address:
  • Phone: 312-558-6481
  • Fax: 312-762-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209-003645
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: