| NPI | 1154738094 |
|---|---|
| Former Name | TIFFANY HATTENDORF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 14722) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9108032) |
| 363A00000X Physician Assistant (Licence: SC 3215) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2024-03-28 |