Individual
TIFFANY SIMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20370 POE SHOLES DR, BEND, OR 97701-7938
(541) 318-1377
Mailing address
2707 NE LARAMIE WAY, BEND, OR 97701-6269
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201391768RN
OR
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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