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Individual

TIFFANY YOUNG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
411 E PEARCE BLVD, WENTZVILLE, MO 63385-1533
(636) 281-8433
Mailing address
411 E PEARCE BLVD, WENTZVILLE, MO 63385-1533
(636) 281-8433

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
2004007868
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2004007868
SPECIALIST
MO
Enumeration date
08/16/2020
Last updated
08/16/2020
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