| NPI | 1689316796 |
|---|---|
| Former Name | TAREYN GREEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA-2364) |
| Enumeration Date | 2022-04-09 |
| Last Update Date | 2026-05-15 |