Provider Demographics
NPI:1043866791
Name:MAYFIELD, TIESE LA DONNA
Entity Type:Individual
Prefix:
First Name:TIESE
Middle Name:LA DONNA
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38832 4TH ST E APT 227
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-3350
Mailing Address - Country:US
Mailing Address - Phone:661-480-7270
Mailing Address - Fax:
Practice Address - Street 1:38832 4TH ST E APT 227
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3350
Practice Address - Country:US
Practice Address - Phone:661-480-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267288164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse