Individual
TIFFANY WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
255 W LUCAS ST, MARENGO, IA 52301-1331
(319) 642-5213
(319) 642-3636
Mailing address
255 W LUCAS ST, MARENGO, IA 52301-1331
(319) 642-5213
(319) 642-3636
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36129
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39640
WELLMARK
—
Enumeration date
10/17/2005
Last updated
04/11/2025
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