Healthcare Provider Details

I. General information

NPI: 1871423111
Provider Name (Legal Business Name): TIFFANY JOTHEN BSN RN LSN NCSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WEST AVE S
WESTBY WI
54667-1227
US

IV. Provider business mailing address

206 WEST AVE S
WESTBY WI
54667-1227
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-0523
  • Fax: 978-313-8521
Mailing address:
  • Phone: 608-634-0523
  • Fax: 978-313-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number156993-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: