Provider Demographics
NPI:1871143347
Name:GREENE, TAWANA (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-3012
Mailing Address - Country:US
Mailing Address - Phone:601-738-5642
Mailing Address - Fax:601-738-5643
Practice Address - Street 1:1304 CLAY ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-3012
Practice Address - Country:US
Practice Address - Phone:601-738-5642
Practice Address - Fax:601-738-5643
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
MS907023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No376J00000XNursing Service Related ProvidersHomemaker