1316664451 NPI number — TIANNA MAE RUSTOM SIGLOH DOULA

Table of content: TIANNA MAE RUSTOM SIGLOH DOULA (NPI 1316664451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316664451 NPI number — TIANNA MAE RUSTOM SIGLOH DOULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIGLOH
Provider First Name:
TIANNA
Provider Middle Name:
MAE RUSTOM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DOULA
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:
1316664451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6466 PALOMINO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LINN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97068-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-645-0908
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6466 PALOMINO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LINN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97068-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-645-0908
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2022

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: 374J00000X , registered in the state of OR ; 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