1295085165 NPI number — MRS. TIANA CORRINE MORELAND CNP

Table of content: MRS. TIANA CORRINE MORELAND CNP (NPI 1295085165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295085165 NPI number — MRS. TIANA CORRINE MORELAND CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELAND
Provider First Name:
TIANA
Provider Middle Name:
CORRINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295085165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
332 DEEP WOODS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-901-8699
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9050 CENTRE POINTE DR
Provider Second Line Business Practice Location Address:
SUITE # 400
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-901-8699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  13793-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com