MEDICARE: TIFFANY RENEE EDMOND RT

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	2278G1100X	General Care Certified Respiratory Therapist	RC3337	NV

General Provider Information

NPI Number	:	1346849106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY RENEE EDMOND RT

Provider Business Mailing Address
First Line	:	3305 E ROME BLVD APT 3104
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1495
Country	:	US
Telephone Number	:	209-676-1865
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 E ROME BLVD APT 3104
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1495
Country	:	US
Telephone Number	:	209-676-1865
Fax Number	:

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

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	10/22/2020

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