Provider Demographics
NPI:1881194900
Name:MUNIZ, TIFFANY ANN (LPN, CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:LPN, CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-1234
Mailing Address - Country:US
Mailing Address - Phone:618-581-8469
Mailing Address - Fax:
Practice Address - Street 1:410 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-1234
Practice Address - Country:US
Practice Address - Phone:618-581-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043.111999164W00000X
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No164W00000XNursing Service ProvidersLicensed Practical Nurse