Provider Demographics
NPI:1679178123
Name:WELZIN, TIFFANI NICOLE (PHLEBOTOMIST/MA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:NICOLE
Last Name:WELZIN
Suffix:
Gender:F
Credentials:PHLEBOTOMIST/MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22976 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4279
Mailing Address - Country:US
Mailing Address - Phone:313-953-8768
Mailing Address - Fax:
Practice Address - Street 1:22976 OUTER DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4279
Practice Address - Country:US
Practice Address - Phone:313-953-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
MI246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No171W00000XOther Service ProvidersContractor