Individual
TIFFANY BARNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8600 N STATE ROUTE 91, SUITE 250, PEORIA, IL 61615-9541
(309) 692-5393
Mailing address
8600 N STATE ROUTE 91, SUITE 250, PEORIA, IL 61615-9541
(309) 692-5393
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041-331429
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
614451001
MEDICARE PTAN
IL
Enumeration date
07/08/2008
Last updated
06/02/2009
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