Healthcare Provider Details

I. General information

NPI: 1750817193
Provider Name (Legal Business Name): TIANNA FINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 MEADE STREET
NORTH BEND OR
97459
US

IV. Provider business mailing address

715 SW RAMSEY AVENUE
GRANTS PASS OR
97527
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-4508
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: