Provider Demographics
NPI:1609409853
Name:TENUMAH, TEMISAN EDWIN
Entity Type:Individual
Prefix:
First Name:TEMISAN
Middle Name:EDWIN
Last Name:TENUMAH
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 1:401 LITTLE TEXAS LN APT 1213
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4126
Mailing Address - Country:US
Mailing Address - Phone:240-447-7682
Mailing Address - Fax:
Practice Address - Street 1:401 LITTLE TEXAS LN APT 1213
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4126
Practice Address - Country:US
Practice Address - Phone:240-447-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145010363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care