Provider Demographics
NPI:1043972250
Name:TOWNSEL, TIFFANY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:TOWNSEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4141
Mailing Address - Country:US
Mailing Address - Phone:708-756-5200
Mailing Address - Fax:708-756-1136
Practice Address - Street 1:120 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-4141
Practice Address - Country:US
Practice Address - Phone:708-756-5200
Practice Address - Fax:708-756-1136
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043112536164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse