Healthcare Provider Details

I. General information

NPI: 1457283640
Provider Name (Legal Business Name): TACIE IRELAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

245 S GRAND AVE
BURNS OR
97720-1964
US

IV. Provider business mailing address

245 S GRAND AVE
BURNS OR
97720-1964
US

V. Phone/Fax

Practice location:
  • Phone: 808-289-6149
  • Fax:
Mailing address:
  • Phone: 808-289-6149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number111874
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: