Provider Demographics
NPI:1467287078
Name:STEPHEN-GREEN, TASHARRA LATRICE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:TASHARRA
Middle Name:LATRICE
Last Name:STEPHEN-GREEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:TASHARRA
Other - Middle Name:LATRICE
Other - Last Name:STEPHENS-GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28120 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-5603
Mailing Address - Country:US
Mailing Address - Phone:586-487-7988
Mailing Address - Fax:
Practice Address - Street 1:28120 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-5603
Practice Address - Country:US
Practice Address - Phone:586-487-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse