Individual
MS. TIFFANI L WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
435 MAXINE DR, MORTON, IL 61550-2498
(309) 263-2424
(309) 284-2244
Mailing address
435 MAXINE DR, MORTON, IL 61550-2498
(309) 263-2424
(309) 284-2244
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-003619
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
553180
MEDICARE GROUP PTAN
IL
01
—
553180037
MEDICARE INDIVIDUAL PTAN
IL
01
—
834340
MEDICARE GROUP PTAN
IL
01
—
834340025
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
12/17/2009
Last updated
10/23/2019
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