Provider Demographics
NPI:1497033591
Name:HARRIS GREENE, TANARA PEKAY (RN)
Entity type:Individual
Prefix:MS
First Name:TANARA
Middle Name:PEKAY
Last Name:HARRIS GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:TANARA
Other - Middle Name:PEKAY
Other - Last Name:HARRIS GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:43 COBURN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2701
Mailing Address - Country:US
Mailing Address - Phone:781-985-6848
Mailing Address - Fax:
Practice Address - Street 1:43 COBURN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2701
Practice Address - Country:US
Practice Address - Phone:781-985-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259413163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator