Healthcare Provider Details

I. General information

NPI: 1730424896
Provider Name (Legal Business Name): TIARA CHEATHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MAINE ST
FALLON NV
89406-2902
US

IV. Provider business mailing address

1665 OLD HOT SPRINGS RD SUITE 157
CARSON CITY NV
89706-0782
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-7141
  • Fax: 775-423-4020
Mailing address:
  • Phone: 775-687-5162
  • Fax: 775-687-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberTRN335544
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: