MEDICARE: TIFFANY MONIQUE THOMPSON

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1548915184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY MONIQUE THOMPSON

Provider Business Mailing Address
First Line	:	6501 W FOND DU LAC AVE UNIT 18771
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-5830
Country	:	US
Telephone Number	:	262-888-9934
Fax Number	:

Provider Business Practice Location Address
First Line	:	3958 N 39TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2517
Country	:	US
Telephone Number	:	262-888-9934
Fax Number	:

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

Provider Enumeration Date	:	02/12/2022
Last Update Date	:	02/12/2022

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