Provider Demographics
NPI:1902395932
Name:WILLERS, TIFFANY ANN (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:WILLERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 NE 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2714
Mailing Address - Country:US
Mailing Address - Phone:503-261-3417
Mailing Address - Fax:
Practice Address - Street 1:1700 E SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5474
Practice Address - Country:US
Practice Address - Phone:503-261-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program