Individual
TIFFANY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5258 N 84TH ST, MILWAUKEE, WI 53225-3502
(414) 514-2919
Mailing address
5258 N 84TH ST, MILWAUKEE, WI 53225-3502
(414) 514-2919
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000000
NONE
—
Enumeration date
03/17/2021
Last updated
03/17/2021
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