Healthcare Provider Details

I. General information

NPI: 1255891727
Provider Name (Legal Business Name): TIFFANY JOY LANG HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. TIFFANY JOY WING

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 VINE ST
HAYS KS
67601-9484
US

IV. Provider business mailing address

4301 VINE ST
HAYS KS
67601-9484
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-3279
  • Fax: 785-628-3898
Mailing address:
  • Phone: 785-628-3279
  • Fax: 785-628-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1637
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: