Individual
MS. TIFFANY L FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1185 CORPORATE CENTER DR STE 300, OCONOMOWOC, WI 53066-4887
(414) 771-6780
(414) 238-2424
Mailing address
10001 W INNOVATION DR STE 200, WAUWATOSA, WI 53226-4851
(414) 771-6780
(414) 238-2424
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2443-023
WI
Other
Enumeration date
07/20/2009
Last updated
04/06/2021
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