Provider Demographics
NPI:1477596294
Name:ANDERSON, TIFFANI L (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:NE
Mailing Address - Zip Code:69145-1261
Mailing Address - Country:US
Mailing Address - Phone:308-235-0017
Mailing Address - Fax:308-235-0018
Practice Address - Street 1:216 S. HOWARD ST.
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:NE
Practice Address - Zip Code:69145-1265
Practice Address - Country:US
Practice Address - Phone:308-235-0017
Practice Address - Fax:308-235-0018
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE274213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU77310Medicare UPIN
NE272066Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER