Provider Demographics
NPI:1164973368
Name:CRUIKSHANK, TIFFANY (LAC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CRUIKSHANK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:VIEHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:7683 SE 27TH ST # 113
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2804
Mailing Address - Country:US
Mailing Address - Phone:347-752-2711
Mailing Address - Fax:
Practice Address - Street 1:7803 SE 27TH ST STE 174
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2139
Practice Address - Country:US
Practice Address - Phone:347-752-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60657603171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist