Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 75218 | KS |
NPI | 1174823553 |
---|---|
Provider Name | Mrs. Tashia Nichole Tjaden |
First Address | Overland Park, KS 66215-2306 |
Second Address | Overland Park, KS 66215-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 18/11/2010 |