Provider Demographics
NPI:1316542343
Name:LITTLEGHOST, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LITTLEGHOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7765 EPHRIN HILL RD W, HOUSE 153
Mailing Address - Street 2:
Mailing Address - City:ST. MICHEAL
Mailing Address - State:ND
Mailing Address - Zip Code:58370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7765 EPHRIN HILL RD W, HOUSE 153
Practice Address - Street 2:
Practice Address - City:ST. MICHEAL
Practice Address - State:ND
Practice Address - Zip Code:58370
Practice Address - Country:US
Practice Address - Phone:701-381-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant