Provider Demographics
NPI:1003174343
Name:BATTENFIELD, TIFFANY LYNN (LMP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:LYNN
Last Name:BATTENFIELD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7707
Mailing Address - Country:US
Mailing Address - Phone:425-319-2376
Mailing Address - Fax:
Practice Address - Street 1:1806 S LAKE STEVENS RD
Practice Address - Street 2:UNIT A
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7959
Practice Address - Country:US
Practice Address - Phone:425-319-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60258959174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist