Healthcare Provider Details

I. General information

NPI: 1578092227
Provider Name (Legal Business Name): TIFFANY APPLEWHITE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W 167TH ST
ORLAND PARK IL
60467-5561
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-4901
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-2400
  • Fax: 708-873-8451
Mailing address:
  • Phone: 847-390-5900
  • Fax: 847-390-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209009928
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041310670
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: