Provider Demographics
NPI:1750697447
Name:MCKENNA, TIFFANI (APN)
Entity type:Individual
Prefix:MS
First Name:TIFFANI
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E BRUSH HILL RD OFC D3331
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5658
Mailing Address - Country:US
Mailing Address - Phone:331-221-0096
Mailing Address - Fax:331-221-3718
Practice Address - Street 1:155 E BRUSH HILL RD OFC D3331
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5658
Practice Address - Country:US
Practice Address - Phone:331-221-0096
Practice Address - Fax:331-221-3718
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008113163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice