MEDICARE: TIFFANY LASETER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN95259210	CA

General Provider Information

NPI Number	:	1194481424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY LASETER RN

Provider Business Mailing Address
First Line	:	18035 STONEY CREEK WAY
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-3570
Country	:	US
Telephone Number	:	703-869-0652
Fax Number	:

Provider Business Practice Location Address
First Line	:	18035 STONEY CREEK WAY
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-3570
Country	:	US
Telephone Number	:	703-869-0652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2021
Last Update Date	:	11/10/2021

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