Provider Demographics
NPI:1053865485
Name:STENZEL, TIFFANY (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:STENZEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 JOHNSON AVE SW
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2539
Mailing Address - Country:US
Mailing Address - Phone:507-835-0685
Mailing Address - Fax:
Practice Address - Street 1:299 JOHNSON AVE SW
Practice Address - Street 2:SUITE 160
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2539
Practice Address - Country:US
Practice Address - Phone:507-835-0685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN214545-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse