Healthcare Provider Details

I. General information

NPI: 1558655787
Provider Name (Legal Business Name): TIFFANY YOLANDA WHITTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38460 OAK HILL LN APT 203
WILLOUGHBY OH
44094-7641
US

IV. Provider business mailing address

38460 OAK HILL LN APT 203
WILLOUGHBY OH
44094-7641
US

V. Phone/Fax

Practice location:
  • Phone: 440-231-5119
  • Fax:
Mailing address:
  • Phone: 440-231-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: