Individual
DR. TIFFANY JEAN MARINIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3111 GUNDERSEN DR, ONALASKA, WI 54650-8447
(608) 775-8630
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036125948
IL
207R00000X
Internal Medicine Physician
102952
MN
207R00000X
Internal Medicine Physician
Primary
60962
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036125948
—
IL
01
—
487450009
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P00897309
MEDICARE RAILROAD (INDIVIDUAL)
IL
Enumeration date
04/06/2007
Last updated
03/24/2014
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