Provider Demographics
NPI:1588376172
Name:LIEURANCE, TATYANA GENNADIEVNA
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:GENNADIEVNA
Last Name:LIEURANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:TERECHINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2502 E FRTH PLN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3965
Mailing Address - Country:US
Mailing Address - Phone:360-852-9092
Mailing Address - Fax:
Practice Address - Street 1:2502 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3965
Practice Address - Country:US
Practice Address - Phone:360-852-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61238405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse