Provider Demographics
NPI:1154173227
Name:SPEARS, TATANESHA GABRIELLE
Entity type:Individual
Prefix:
First Name:TATANESHA
Middle Name:GABRIELLE
Last Name:SPEARS
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 1:21315 FRAZER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3855
Mailing Address - Country:US
Mailing Address - Phone:248-835-9053
Mailing Address - Fax:
Practice Address - Street 1:21315 FRAZER AVE
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3855
Practice Address - Country:US
Practice Address - Phone:248-835-9053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide