Healthcare Provider Details

I. General information

NPI: 1265215438
Provider Name (Legal Business Name): CIERRA TJADEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CIERRA GRAHAM

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 S 84TH ST
LINCOLN NE
68516-4405
US

IV. Provider business mailing address

3565 N 89TH ST
LINCOLN NE
68507-9306
US

V. Phone/Fax

Practice location:
  • Phone: 402-480-0250
  • Fax:
Mailing address:
  • Phone: 402-430-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2721
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: