Healthcare Provider Details

I. General information

NPI: 1073023750
Provider Name (Legal Business Name): TIERNY WILBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 10/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WHITNEY MESA DR
HENDERSON NV
89014-2080
US

IV. Provider business mailing address

1711 WHITNEY MESA DR
HENDERSON NV
89014-2080
US

V. Phone/Fax

Practice location:
  • Phone: 702-385-2090
  • Fax: 702-448-8101
Mailing address:
  • Phone: 702-385-2090
  • Fax: 702-448-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: