Individual
TIANA M IMHOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3158-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487094686
BCBSWI
WI
05
—
1487094686
—
WI
01
—
WEISSTIA
MERCYCARE INSURANCE
WI
Enumeration date
07/02/2013
Last updated
11/27/2023
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