Provider Demographics
NPI:1205324563
Name:MACARAEG, TIFFANY ANN (LPN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:MACARAEG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 S 187TH PL APT D306
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98188-8635
Mailing Address - Country:US
Mailing Address - Phone:702-882-4641
Mailing Address - Fax:
Practice Address - Street 1:611 S 132ND ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98168-2764
Practice Address - Country:US
Practice Address - Phone:206-631-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60738531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP60738531OtherLICENSE PRACTICAL NURSE