Provider Demographics
NPI:1881853992
Name:GREEN, TASHUNDA LATRESE (RN)
Entity Type:Individual
Prefix:MS
First Name:TASHUNDA
Middle Name:LATRESE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17830 LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1131
Mailing Address - Country:US
Mailing Address - Phone:708-799-6740
Mailing Address - Fax:
Practice Address - Street 1:17830 LARKSPUR LN
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1131
Practice Address - Country:US
Practice Address - Phone:708-799-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041310372163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care