Provider Demographics
NPI:1710783980
Name:TIAP, WAL M I
Entity type:Individual
Prefix:
First Name:WAL
Middle Name:M
Last Name:TIAP
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N 27TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3102
Mailing Address - Country:US
Mailing Address - Phone:402-770-2395
Mailing Address - Fax:
Practice Address - Street 1:2610 W M CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1006
Practice Address - Country:US
Practice Address - Phone:402-325-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH12728214373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist