Provider Demographics
NPI:1295498970
Name:GRESHAM, TIESHA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:TIESHA
Middle Name:
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GENE REED RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8260
Mailing Address - Country:US
Mailing Address - Phone:205-407-5718
Mailing Address - Fax:205-407-5802
Practice Address - Street 1:500 GENE REED RD STE 103
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8260
Practice Address - Country:US
Practice Address - Phone:205-407-5718
Practice Address - Fax:205-407-5802
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109186163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator