Provider Demographics
NPI:1659234870
Name:TINAJERO, BIANCA ANNABELLE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ANNABELLE
Last Name:TINAJERO
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 1:2320 GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1437
Mailing Address - Country:US
Mailing Address - Phone:308-380-6418
Mailing Address - Fax:
Practice Address - Street 1:2320 GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1437
Practice Address - Country:US
Practice Address - Phone:308-380-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH14266516172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver