Healthcare Provider Details

I. General information

NPI: 1366907842
Provider Name (Legal Business Name): MIA RENEE TATMAN RRT, RRT-ACCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 N MAIN ST
PUEBLO CO
81003-2439
US

IV. Provider business mailing address

2427 N MAIN ST
PUEBLO CO
81003-2439
US

V. Phone/Fax

Practice location:
  • Phone: 719-415-2921
  • Fax:
Mailing address:
  • Phone: 719-415-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: