Provider Demographics
NPI:1760722714
Name:KIBLER, TIFFANY M (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:KIBLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 ROYCE RD
Mailing Address - Street 2:
Mailing Address - City:VARYSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14167-9727
Mailing Address - Country:US
Mailing Address - Phone:585-519-2594
Mailing Address - Fax:
Practice Address - Street 1:67 MILL ST
Practice Address - Street 2:APT 102
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-9532
Practice Address - Country:US
Practice Address - Phone:585-468-6039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311679164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse