1760296479 NPI number — MS. QUELIFFUER JIREH SUYAMIN TANO RN

Table of content: MS. QUELIFFUER JIREH SUYAMIN TANO RN (NPI 1760296479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760296479 NPI number — MS. QUELIFFUER JIREH SUYAMIN TANO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANO
Provider First Name:
QUELIFFUER JIREH
Provider Middle Name:
SUYAMIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1760296479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 E 2ND AVE
Provider Second Line Business Mailing Address:
APT 2
Provider Business Mailing Address City Name:
RITZVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-687-6173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 S ADAMS ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RITZVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-659-1200
Provider Business Practice Location Address Fax Number:
509-659-1832
Provider Enumeration Date:
02/03/2025

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: 163WM0705X , with the licence number:  RN61560128 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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