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Individual

TIFFANY R HARRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(920) 337-6740
Mailing address
2357 W MASON ST, GREEN BAY, WI 54303-4708
(920) 337-6740

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34087-31
WI

Other

Enumeration date
02/01/2023
Last updated
02/01/2023
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