Basic Information
| Provider Information | |||||||||
| NPI: | 1528011590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHECHEK | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASADIA | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 300 S BYRON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHAMBERLAIN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573259741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052346551 | ||||||||
| FaxNumber: | 6052347260 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 S BYRON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHAMBERLAIN | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573259741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052346551 | ||||||||
| FaxNumber: | 6052347260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/31/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5408 | SD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.