Provider Demographics
NPI:1225388150
Name:DAY, TIFFANEY LEORA (RSA)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANEY
Middle Name:LEORA
Last Name:DAY
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7522
Mailing Address - Country:US
Mailing Address - Phone:217-418-0208
Mailing Address - Fax:
Practice Address - Street 1:401 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4716
Practice Address - Country:US
Practice Address - Phone:217-398-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker