Healthcare Provider Details

I. General information

NPI: 1124398391
Provider Name (Legal Business Name): TIFFANY RHODES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY FIEDLER CRNA

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

IV. Provider business mailing address

18101 OAKWOOD BLVD
DEARBORN MI
48124-4089
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2374
  • Fax:
Mailing address:
  • Phone: 313-436-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704254228
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: