Provider Demographics
NPI:1790806180
Name:GREEN, TAMIKA (CNA)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0483
Mailing Address - Country:US
Mailing Address - Phone:484-547-1594
Mailing Address - Fax:
Practice Address - Street 1:203 E SUSQUEHANNA ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5139
Practice Address - Country:US
Practice Address - Phone:484-547-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9922023390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program