Individual
MRS. TRISHA ROSE TIFFANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 423-5431
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 436-5431
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27061524A
IN
Other
Enumeration date
03/14/2023
Last updated
03/14/2023
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