Provider Demographics
NPI:1255030128
Name:PRICE, TIARA CHANELLE (RN)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:CHANELLE
Last Name:PRICE
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 1:4129 SILVER PARK TER
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3051
Mailing Address - Country:US
Mailing Address - Phone:202-422-5312
Mailing Address - Fax:
Practice Address - Street 1:4129 SILVER PARK TER
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-3051
Practice Address - Country:US
Practice Address - Phone:202-422-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR247562163W00000X
DCRN1058186163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse