Provider Demographics
NPI:1548009913
Name:LOUIE, TIFFANY VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VICTORIA
Last Name:LOUIE
Suffix:
Gender:F
Credentials:PA-C
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 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:120 SPALDING DR STE 100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6526
Practice Address - Country:US
Practice Address - Phone:630-961-0423
Practice Address - Fax:630-961-9280
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118709363A00000X
IL085-011225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant