Individual
MISS TIFFANY TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2054 N 24TH PL, MILWAUKEE, WI 53205-1003
(414) 218-5637
Mailing address
2054 N 24TH PL, MILWAUKEE, WI 53205-1003
(414) 218-5637
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
303621
WI
Other
Enumeration date
10/29/2014
Last updated
10/29/2014
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