Provider Demographics
NPI:1013431345
Name:MCNAIR, TIFFANIE (CNA,MA)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:MCNAIR
Suffix:
Gender:F
Credentials:CNA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 ROMAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60436-1131
Mailing Address - Country:US
Mailing Address - Phone:815-955-8071
Mailing Address - Fax:
Practice Address - Street 1:306 ROMAYNE AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60436
Practice Address - Country:US
Practice Address - Phone:815-955-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide