Provider Demographics
NPI:1033835558
Name:GUTHRIE, TIFFANY RENEE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 N DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1312
Mailing Address - Country:US
Mailing Address - Phone:126-238-9094
Mailing Address - Fax:
Practice Address - Street 1:8702 N DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-1312
Practice Address - Country:US
Practice Address - Phone:262-389-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management