Healthcare Provider Details

I. General information

NPI: 1386499606
Provider Name (Legal Business Name): TIFFANY L BUI APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S 80TH AVE STE 203
PALOS HEIGHTS IL
60463-1284
US

IV. Provider business mailing address

12255 S 80TH AVE STE 203
PALOS HEIGHTS IL
60463-1284
US

V. Phone/Fax

Practice location:
  • Phone: 708-827-2021
  • Fax: 708-827-2241
Mailing address:
  • Phone: 708-827-2021
  • Fax: 708-827-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.029577
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: