Provider Demographics
NPI:1013639269
Name:JENNIGES, TIFFANY LEA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEA
Last Name:JENNIGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CEDAR ST STE 46
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1787
Mailing Address - Country:US
Mailing Address - Phone:612-770-8803
Mailing Address - Fax:
Practice Address - Street 1:700 CEDAR ST STE 46
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1787
Practice Address - Country:US
Practice Address - Phone:612-770-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier