Provider Demographics
NPI:1902801293
Name:ATHEY, TIFFANY (MSN, APN)
Entity Type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:
Last Name:ATHEY
Suffix:
Gender:F
Credentials:MSN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1008
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1008
Mailing Address - Country:US
Mailing Address - Phone:312-558-6481
Mailing Address - Fax:312-762-3919
Practice Address - Street 1:30 N MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4495
Practice Address - Country:US
Practice Address - Phone:312-558-6481
Practice Address - Fax:312-762-3919
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003645363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health