Individual
TIFFANY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1610 MILLER PARK WAY, WEST MILWAUKEE, WI 53214-3604
(414) 672-3801
Mailing address
1941 W KEEFE AVE, MILWAUKEE, WI 53206-2326
(414) 795-0126
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
325083
WI
Other
Enumeration date
11/23/2020
Last updated
11/23/2020
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