Provider Demographics
NPI:1215380175
Name:RUFFIN, TIHIRA NICHELLE
Entity type:Individual
Prefix:MS
First Name:TIHIRA
Middle Name:NICHELLE
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1719
Mailing Address - Country:US
Mailing Address - Phone:313-833-1168
Mailing Address - Fax:313-832-8606
Practice Address - Street 1:3745 CASS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1719
Practice Address - Country:US
Practice Address - Phone:313-833-1168
Practice Address - Fax:313-832-8606
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942397195OtherSKILL BUILDING