Provider Demographics
NPI:1184456667
Name:LETOURNEAU, TIFFANY ANN
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:ANN
Last Name:LETOURNEAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:G3169 BEECHER RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3611
Mailing Address - Country:US
Mailing Address - Phone:810-922-9472
Mailing Address - Fax:
Practice Address - Street 1:G3169 BEECHER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3611
Practice Address - Country:US
Practice Address - Phone:810-922-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator