Provider Demographics
NPI:1831915933
Name:LUNDY, TIFFANIE (APRN)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:LUNDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:
Other - Last Name:CLEMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 SANTA FE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9355
Mailing Address - Country:US
Mailing Address - Phone:309-224-2795
Mailing Address - Fax:
Practice Address - Street 1:1405 SANTA FE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9355
Practice Address - Country:US
Practice Address - Phone:309-224-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.031125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily