Basic Information
Provider Information
NPI: 1710251715
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRANKLIN
FirstName: TIFFANEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 579 E FERRY ST
Address2:  
City: BUFFALO
State: NY
PostalCode: 142111109
CountryCode: US
TelephoneNumber: 7166054786
FaxNumber:  
Practice Location
Address1: 1680 WALDEN AVE
Address2:  
City: CHEEKTOWAGA
State: NY
PostalCode: 142254914
CountryCode: US
TelephoneNumber: 7168947777
FaxNumber: 7168940604
Other Information
ProviderEnumerationDate: 03/08/2012
LastUpdateDate: 03/08/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000X292417NYY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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