Provider Demographics
NPI:1861236416
Name:DRAPER, TIANNA RAYN
Entity type:Individual
Prefix:
First Name:TIANNA
Middle Name:RAYN
Last Name:DRAPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIANNA
Other - Middle Name:RAYN
Other - Last Name:SHURTLEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1855 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3425
Mailing Address - Country:US
Mailing Address - Phone:503-857-8766
Mailing Address - Fax:
Practice Address - Street 1:1855 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3425
Practice Address - Country:US
Practice Address - Phone:503-857-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109559374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula