Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP08634 | LA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP08634 | LA |
NPI | 1790130664 |
---|---|
Provider Name | Tiffini Lundy |
First Address | Clinton, LA 70722-0395 |
Second Address | Clinton, LA 70722-3210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2435299 | (05) | LA |