Individual
TIFFANY MAY RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2401 W MAIN ST, MARION, IL 62959-1188
(618) 997-5311
Mailing address
207 S MAIN ST, ZEIGLER, IL 62999-1123
(618) 559-1813
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043090575
IL
Other
Enumeration date
04/19/2023
Last updated
04/19/2023
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