Healthcare Provider Details

I. General information

NPI: 1447173679
Provider Name (Legal Business Name): TIFFANY ANN RAISBECK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ANN HOPPMAN RN

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N JUDGEMENT ST
SHULLSBURG WI
53586-9414
US

IV. Provider business mailing address

7750 LAKEVIEW RD
BARNEVELD WI
53507-9352
US

V. Phone/Fax

Practice location:
  • Phone: 608-965-4427
  • Fax:
Mailing address:
  • Phone: 608-412-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number251506
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: