Provider Demographics
NPI:1578384509
Name:TANGIM, VERA EMENYI
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:EMENYI
Last Name:TANGIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1219
Mailing Address - Country:US
Mailing Address - Phone:774-707-6062
Mailing Address - Fax:
Practice Address - Street 1:337 GRANITE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1219
Practice Address - Country:US
Practice Address - Phone:774-707-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2359488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse