Provider Demographics
NPI:1962860957
Name:CUMMINGS, TIANNA (MA 60560900)
Entity Type:Individual
Prefix:
First Name:TIANNA
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MA 60560900
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 EASTGATE ST
Mailing Address - Street 2:#110
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2554
Mailing Address - Country:US
Mailing Address - Phone:509-527-1156
Mailing Address - Fax:509-522-4933
Practice Address - Street 1:2316 EASTGATE ST
Practice Address - Street 2:#110
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2554
Practice Address - Country:US
Practice Address - Phone:509-527-1156
Practice Address - Fax:509-522-4933
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60560900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist