Provider Demographics
NPI:1205160652
Name:VANEIMEREN, TIFFANIE RENEE (NP)
Entity type:Individual
Prefix:MRS
First Name:TIFFANIE
Middle Name:RENEE
Last Name:VANEIMEREN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W CHICORY LANE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108
Mailing Address - Country:US
Mailing Address - Phone:605-335-0056
Mailing Address - Fax:605-334-0056
Practice Address - Street 1:808 W CHICORY LN
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2808
Practice Address - Country:US
Practice Address - Phone:605-335-0056
Practice Address - Fax:605-334-0556
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000295363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner