Individual
MRS. TIFFANY LOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110003457
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110003457
LICENSE
VA
Enumeration date
01/29/2007
Last updated
07/10/2013
Update your record
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