Provider Demographics
NPI:1386180578
Name:SCHENK, TIFFANY (RN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:SCHENK
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 1:1501 HILAND AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-2688
Mailing Address - Country:US
Mailing Address - Phone:208-677-6290
Mailing Address - Fax:208-878-8430
Practice Address - Street 1:1501 HILAND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2688
Practice Address - Country:US
Practice Address - Phone:208-677-6290
Practice Address - Fax:208-878-8430
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-37882163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator