Provider Demographics
NPI:1194863498
Name:TENNEY, THARA
Entity Type:Individual
Prefix:MRS
First Name:THARA
Middle Name:
Last Name:TENNEY
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 1:18762 N COMET TRL
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5808
Mailing Address - Country:US
Mailing Address - Phone:928-533-7869
Mailing Address - Fax:
Practice Address - Street 1:755 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5877
Practice Address - Country:US
Practice Address - Phone:928-533-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist