Healthcare Provider Details

I. General information

NPI: 1457686750
Provider Name (Legal Business Name): KIERA A TANNER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 10/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 BLACK SEA ST
NORTH LAS VEGAS NV
89031-0443
US

IV. Provider business mailing address

5506 BLACK SEA ST
NORTH LAS VEGAS NV
89031-0443
US

V. Phone/Fax

Practice location:
  • Phone: 702-540-1844
  • Fax:
Mailing address:
  • Phone: 702-540-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT 3237
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: