1396633558 NPI number — TIFFANY LYNN-MARIE WALKER CNA, CMA

Table of content: TIFFANY LYNN-MARIE WALKER CNA, CMA (NPI 1396633558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396633558 NPI number — TIFFANY LYNN-MARIE WALKER CNA, CMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
TIFFANY
Provider Middle Name:
LYNN-MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA, CMA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MERIZALDE
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
LYNN-MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNA,CMA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396633558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3950 N 104TH PLZ APT 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68134-7746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-658-2249
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3950 N 104TH PLZ APT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68134-7746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-658-2249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2025

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: 373H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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