Healthcare Provider Details

I. General information

NPI: 1457737868
Provider Name (Legal Business Name): TIFFANY PRIVATE DUTY NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SEVERT LN
ROSEVILLE OH
43777-1179
US

IV. Provider business mailing address

42 SEVERT LN
ROSEVILLE OH
43777-1179
US

V. Phone/Fax

Practice location:
  • Phone: 740-624-6802
  • Fax:
Mailing address:
  • Phone: 740-624-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number112098
License Number StateOH

VIII. Authorized Official

Name: MS. TIFFANY LUDWIG
Title or Position: LPN/OWNER
Credential:
Phone: 740-624-6802