Provider Demographics
NPI:1497127815
Name:TIETCHEU, MARIA G (CRNP-PMH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:G
Last Name:TIETCHEU
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 MONTGOMERY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4436
Mailing Address - Country:US
Mailing Address - Phone:240-644-9396
Mailing Address - Fax:
Practice Address - Street 1:4424 MONTGOMERY AVE STE 201
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4436
Practice Address - Country:US
Practice Address - Phone:240-644-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR179531363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health