Healthcare Provider Details

I. General information

NPI: 1134087703
Provider Name (Legal Business Name): TANA BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

IV. Provider business mailing address

531 164TH ST
DAKOTA CITY NE
68731-3013
US

V. Phone/Fax

Practice location:
  • Phone: 712-279-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberG188757
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: