Provider Demographics
NPI:1013752575
Name:GREEN, TRICIA D (CNA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:D
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 1:7808 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8141
Mailing Address - Country:US
Mailing Address - Phone:410-440-8787
Mailing Address - Fax:
Practice Address - Street 1:7808 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8141
Practice Address - Country:US
Practice Address - Phone:410-440-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20160876251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health