Individual
MRS. TIFFANY SHANTA HAROLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1011 BOWLES AVE, FENTON, MO 63026-2395
(636) 496-5438
(636) 496-4998
Mailing address
1011 BOWLES AVE, FENTON, MO 63026-2395
(636) 496-5438
(636) 496-4998
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
2017041087
MO
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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