Provider Demographics
NPI:1568766459
Name:PUTNAM-NORTHRUP, TIFFANY (RN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:PUTNAM-NORTHRUP
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 1:138 CECIL A MALONE DR
Mailing Address - Street 2:VISITING NURSE SERVICE
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-273-0466
Mailing Address - Fax:607-277-1494
Practice Address - Street 1:138 CECIL A MALONE DR
Practice Address - Street 2:VISITING NURSE SERVICE
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-0466
Practice Address - Fax:607-277-1494
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY446757-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse