MEDICARE: TIFFANY WASHINGTON

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	:	1679830830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY WASHINGTON

Provider Business Mailing Address
First Line	:	10101 FORUM PARK
Second Line	:	APT. 2072
City	:	HOUSTON
State	:	TX
Zip	:	77036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10101 FORUM PARK DR
Second Line	:	APT. 2072
City	:	HOUSTON
State	:	TX
Zip	:	77036-8101
Country	:	US
Telephone Number	:	832-423-4951
Fax Number	:

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/12/2012

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Directions to “ TIFFANY WASHINGTON ” Practice Location

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