Provider Demographics
NPI:1215778733
Name:DEGESTEIN, TIFFNY
Entity type:Individual
Prefix:
First Name:TIFFNY
Middle Name:
Last Name:DEGESTEIN
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 1:2775 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-9512
Mailing Address - Country:US
Mailing Address - Phone:701-317-0185
Mailing Address - Fax:
Practice Address - Street 1:2775 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-9512
Practice Address - Country:US
Practice Address - Phone:701-317-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care