Provider Information for 1982149399
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TIFFANY VERHASSELT QTT
Other Names:Former Name:TIFFANY THORNTONSex: Female
NPI: 1982149399
Last Updated: 2018-07-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1982149399 | ||||||||
| Enumeration Date | 2016-12-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1508 NEW PINERY RD PORTAGE, WI 53901-1312 United States Phone: 608-745-4900 | Fax: | ||||||||
| Primary Practice Address | 1508 NEW PINERY RD PORTAGE, WI 53901 United States Phone: 608-745-4900 | Fax: | ||||||||
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