Provider Demographics
NPI:1851593842
Name:HART, TENA MARIE (LMP)
Entity Type:Individual
Prefix:MS
First Name:TENA
Middle Name:MARIE
Last Name:HART
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 COUNTRY BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4639
Mailing Address - Country:US
Mailing Address - Phone:360-303-5488
Mailing Address - Fax:
Practice Address - Street 1:2278 COUNTRY BROOK CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4639
Practice Address - Country:US
Practice Address - Phone:360-303-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021636174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist