Most Relevant Information
Provider Data
| NPI Number: | 1003388463 |
| Provider Name: | TIFFANY ANN SHINNICK |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209018490 |
Most Important Dates
| Enumeration Date: | 12/26/2018 |
| Last Updated: | 12/26/2018 |
Provider Practice Location
1650 MIDTOWN RD
PERU
IL
613541200
Practice Location Phone/Fax
| Phone: | 8152202645 |
| Fax: |
Provider Mailing Location
1650 MIDTOWN RD
PERU
IL
613541200
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |