Provider Demographics
NPI:1437414976
Name:FENTA, TIRU ANTENEH
Entity Type:Individual
Prefix:
First Name:TIRU
Middle Name:ANTENEH
Last Name:FENTA
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 1:620 SHERDIAN STREET
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783
Mailing Address - Country:US
Mailing Address - Phone:240-491-2419
Mailing Address - Fax:
Practice Address - Street 1:620 SHERDIAN STREET
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:240-491-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide