Provider Demographics
NPI:1780244897
Name:HARDERS, TIFFANY DIANN (CPO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANN
Last Name:HARDERS
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 DELL RANGE BLVD STE H
Mailing Address - Street 2:BOX 265
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4946
Mailing Address - Country:US
Mailing Address - Phone:307-316-3098
Mailing Address - Fax:252-429-7697
Practice Address - Street 1:2016 S GREELEY HWY UNIT 16B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3793
Practice Address - Country:US
Practice Address - Phone:307-316-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPO04209222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist