Provider Demographics
NPI:1083000509
Name:STONE, TIFFANY ELIZABETH SUE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH SUE
Last Name:STONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ELIZABETH SUE
Other - Last Name:GOADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2144 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-1543
Mailing Address - Country:US
Mailing Address - Phone:405-761-9483
Mailing Address - Fax:
Practice Address - Street 1:2144 HARBOR DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-1543
Practice Address - Country:US
Practice Address - Phone:405-761-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program