Provider Demographics
NPI:1821845694
Name:THOMAS, TIFFANY MARIE-LE (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE-LE
Last Name:THOMAS
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 1:10041 ENDICOTT ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1281
Mailing Address - Country:US
Mailing Address - Phone:734-899-0714
Mailing Address - Fax:
Practice Address - Street 1:10041 ENDICOTT ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1281
Practice Address - Country:US
Practice Address - Phone:734-899-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703124740164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse