Provider Demographics
NPI:1699864538
Name:BRENISER, TIFFANY (RN)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:BRENISER
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 1:3390 PORTER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-9783
Mailing Address - Country:US
Mailing Address - Phone:716-791-4180
Mailing Address - Fax:
Practice Address - Street 1:3390 PORTER CENTER RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:NY
Practice Address - Zip Code:14174-9783
Practice Address - Country:US
Practice Address - Phone:716-791-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY480854-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480854-1OtherRN