Provider Demographics
NPI:1588479075
Name:CONLEY, TIFFANY FAWN (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FAWN
Last Name:CONLEY
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 1:2120 QUARRY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426
Mailing Address - Country:US
Mailing Address - Phone:616-422-6941
Mailing Address - Fax:
Practice Address - Street 1:950 28TH ST SE STE 101E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-1399
Practice Address - Country:US
Practice Address - Phone:616-422-6941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704305661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse