Provider Demographics
NPI:1285184432
Name:BLANDENBERG, TIFFANY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNN
Last Name:BLANDENBERG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9040 JACKSON AVE, ATTN: MCHJ-CLQ-C
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-0770
Mailing Address - Fax:253-968-2826
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9040 JACKSON AVE, ATTN: MCHJ-CLQ-C
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-0770
Practice Address - Fax:253-968-2826
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00041962164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse