Provider Demographics
NPI:1174705735
Name:BREITENBACH, TIFFANY N (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:BREITENBACH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 MARKHAM RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9139
Mailing Address - Country:US
Mailing Address - Phone:740-947-6727
Mailing Address - Fax:
Practice Address - Street 1:769 MARKHAM RD.
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9695
Practice Address - Country:US
Practice Address - Phone:740-947-6727
Practice Address - Fax:740-947-4226
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH330525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse