Provider Demographics
NPI:1437011640
Name:MILDER, TIFFANY R
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:R
Last Name:MILDER
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:IA
Mailing Address - Zip Code:52752-0400
Mailing Address - Country:US
Mailing Address - Phone:563-260-2169
Mailing Address - Fax:
Practice Address - Street 1:2213 2ND ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1205
Practice Address - Country:US
Practice Address - Phone:319-688-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP56895164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty