Provider Demographics
NPI:1740907690
Name:WILLIAMSON, TIFFANY NICHOLE (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICHOLE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N COLUMBUS ST STE B
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3092
Mailing Address - Country:US
Mailing Address - Phone:740-901-3150
Mailing Address - Fax:
Practice Address - Street 1:1550 SHERIDAN DR STE 202
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1380
Practice Address - Country:US
Practice Address - Phone:740-808-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.176513.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse