Individual
TIFFANY KAY LAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
21233 N 79TH DR, PEORIA, AZ 85382-4454
(623) 313-2342
Mailing address
21233 N 79TH DR, PEORIA, AZ 85382-4454
(623) 313-2342
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP044259
AZ
Other
Enumeration date
08/10/2009
Last updated
08/10/2009
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