Provider Demographics
NPI:1336448471
Name:ROOKER, TIFFANY (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ROOKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4706 W BRENTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6024
Mailing Address - Country:US
Mailing Address - Phone:414-526-2410
Mailing Address - Fax:
Practice Address - Street 1:4706 W BRENTWOOD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6024
Practice Address - Country:US
Practice Address - Phone:414-526-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI313548-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse