Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2011006710 | MO |
NPI | 1003114802 |
---|---|
Provider Name | Tiffany J. Vorderstrasse |
First Address | Saint Joseph, MO 64506-3514 |
Second Address | St. Joseph, MO 64506-3514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2011 |
Last Update Date | 11/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003114802 | (05) | MO |
200691530A | (05) | KS |