Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 75 | TN |
NPI | 1083124663 |
---|---|
Provider Name | Tanya Green |
First Address | Spring Hill, TN 37174-2596 |
Second Address | Spring Hill, TN 37174-2596 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2017 |
Last Update Date | 09/10/2017 |