Provider Demographics
NPI:1376809103
Name:TENDO, LAWRENCE A
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:A
Last Name:TENDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WINTHROP AVE # 1
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-5024
Mailing Address - Country:US
Mailing Address - Phone:617-905-4724
Mailing Address - Fax:
Practice Address - Street 1:65 WINTHROP AVE # 1
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-5024
Practice Address - Country:US
Practice Address - Phone:617-905-4724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270380163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse