Provider Demographics
NPI:1639446339
Name:YOUNG, TIFFINI DAWN (CNM)
Entity Type:Individual
Prefix:
First Name:TIFFINI
Middle Name:DAWN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TIFFINI
Other - Middle Name:DAWN
Other - Last Name:STOROR/SCHABACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1687
Mailing Address - Country:US
Mailing Address - Phone:970-256-6322
Mailing Address - Fax:970-263-2691
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:SUITE 240
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1002
Practice Address - Country:US
Practice Address - Phone:970-263-7908
Practice Address - Fax:970-245-0656
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCNM170021176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife