Provider Demographics
NPI:1437498219
Name:REID, TIFFANY D
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:REID
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 1:10063 DAYCREST DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4897
Mailing Address - Country:US
Mailing Address - Phone:513-800-3332
Mailing Address - Fax:
Practice Address - Street 1:10063 DAYCREST DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45246-4897
Practice Address - Country:US
Practice Address - Phone:513-800-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 133718164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse