Provider Demographics
NPI:1578920567
Name:TATEFUA, FNU TERENCE
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:TERENCE
Last Name:TATEFUA
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 1:13507 AVEBURY DR APT 21
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3435
Mailing Address - Country:US
Mailing Address - Phone:240-486-2952
Mailing Address - Fax:
Practice Address - Street 1:13507 AVEBURY DR APT 21
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3435
Practice Address - Country:US
Practice Address - Phone:240-486-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11780374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide