Provider Demographics
NPI:1497072912
Name:SCHULTHEIS, TIFFANY LEIGH (RN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEIGH
Last Name:SCHULTHEIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LEIGH
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4507 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:FULTS
Mailing Address - State:IL
Mailing Address - Zip Code:62244-1529
Mailing Address - Country:US
Mailing Address - Phone:618-458-7398
Mailing Address - Fax:
Practice Address - Street 1:4507 ASHLEY LN
Practice Address - Street 2:
Practice Address - City:FULTS
Practice Address - State:IL
Practice Address - Zip Code:62244-1529
Practice Address - Country:US
Practice Address - Phone:618-458-7398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041356623163W00000X
MO2005008604163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse