Provider Demographics
NPI:1346040177
Name:MILLER, TIFFANY MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11964 N COUNTY ROAD T
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-7338
Mailing Address - Country:US
Mailing Address - Phone:651-380-3081
Mailing Address - Fax:
Practice Address - Street 1:10594 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6658
Practice Address - Country:US
Practice Address - Phone:715-416-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1102327163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health