Healthcare Provider Details

I. General information

NPI: 1255639001
Provider Name (Legal Business Name): TIFFANY J KIRCHNER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY J WOLFGRAM

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11104 PARKVIEW CIRCLE DR STE 10
FORT WAYNE IN
46845-1733
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-6800
  • Fax: 260-425-6845
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number71006850A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: