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Individual

TIFFANY POWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
4047 32ND AVE, KENOSHA, WI 53144-1914
(262) 914-2216
Mailing address
6815 32ND AVE, KENOSHA, WI 53142-3447
(262) 914-2216

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
0016623
WI

Other

Enumeration date
05/08/2023
Last updated
05/08/2023
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