Provider Demographics
NPI:1619791035
Name:HAWLEY, TIFFANY (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GAMMAN
Mailing Address - Street 1:2918 CAVALERO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4518
Mailing Address - Country:US
Mailing Address - Phone:068-509-0922
Mailing Address - Fax:
Practice Address - Street 1:1615 75TH ST SW STE 210
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6293
Practice Address - Country:US
Practice Address - Phone:425-261-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61580054163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health