Healthcare Provider Details

I. General information

NPI: 1003623372
Provider Name (Legal Business Name): GEENA ELDA TIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DODGE ST
BEVERLY MA
01915-1711
US

IV. Provider business mailing address

34 GLENVALE AVE
BILLERICA MA
01821-6028
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-2171
  • Fax:
Mailing address:
  • Phone: 757-339-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2349684
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: