Healthcare Provider Details

I. General information

NPI: 1750697447
Provider Name (Legal Business Name): TIFFANI L. MCKENNA APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD OFC D3331
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

155 E BRUSH HILL RD OFC D3331
ELMHURST IL
60126-5658
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-0096
  • Fax: 331-221-3718
Mailing address:
  • Phone: 331-221-0096
  • Fax: 331-221-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008113
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: