Doctor Name: | MS. TIFFANY JEAN TATE |
NPI Number: | 1609021823 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED. |
License Number: | 385H00000X |
Business Practice Address: | 2245 Coyote Loop Wilson, WY - 830149668 |
Business Phone Number: | 3076906189 |
Business Fax Number: | |
Mailing Address: | 2245 Coyote Loop, WILSON |
State: | WY |
Postal Code: | 830149668 |
Phone Number: | 3076906189 |
Fax Number: | |
NPI Enumeration Date: | 12/02/2008 |
NPI Last Update Date: | 12/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | 385H00000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |