Provider Demographics
NPI:1194359059
Name:CHINN, TIFFANY L (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:CHINN
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 1:1149 E AVENUE K14
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2947
Mailing Address - Country:US
Mailing Address - Phone:414-530-7192
Mailing Address - Fax:
Practice Address - Street 1:1149 E AVENUE K14
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2947
Practice Address - Country:US
Practice Address - Phone:414-530-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA711899163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice