Provider Demographics
NPI:1023493053
Name:KUDLAWIEC, TIFFANY (CRNA)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:KUDLAWIEC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1059 DRAYSON DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8298
Mailing Address - Country:US
Mailing Address - Phone:724-554-9551
Mailing Address - Fax:
Practice Address - Street 1:1059 DRAYSON DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8298
Practice Address - Country:US
Practice Address - Phone:724-554-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.18197367500000X
NC252791367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered