1144352261 NPI number — TIFFANY NICHOLE JOHNSON-DUNN CRNA

Table of content: TIFFANY NICHOLE JOHNSON-DUNN CRNA (NPI 1144352261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144352261 NPI number — TIFFANY NICHOLE JOHNSON-DUNN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON-DUNN
Provider First Name:
TIFFANY
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144352261
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 S. DIXIE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-293-0247
Provider Business Mailing Address Fax Number:
937-293-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 STRAIGHT STREET
Provider Second Line Business Practice Location Address:
MILLENIUM ANESTHESIA LLC
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  COA09313-NA , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200855630 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000506905 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2743455 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100018220 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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