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General NPI Number Information
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NPI Number | 1285597104
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Entity Type | Individual
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Provider Name | TIFFANY M ETIENNE
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 184 WILLIAMSBURG ST
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5720
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Country | US
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Telephone | 337-437-4014
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Fax | 337-437-8283
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Provider Business Mailing Address
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Address Line | 1010 FIELD ST
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City | WESTLAKE
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State | LA
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Zip | 70669-5202
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Country | US
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Telephone | 337-660-6188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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