Provider Demographics
NPI:1881882488
Name:LAWRENCE, TIFFANY (ASN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:ASN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2418
Mailing Address - Country:US
Mailing Address - Phone:859-431-3052
Mailing Address - Fax:859-431-3055
Practice Address - Street 1:722 SCOTT ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2418
Practice Address - Country:US
Practice Address - Phone:859-431-3052
Practice Address - Fax:859-431-3055
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY114815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYFEDERAL TAX ID NUMBEOther610661458