Provider Demographics
NPI:1609484005
Name:CHANG, TENETA PAULETTE
Entity Type:Individual
Prefix:
First Name:TENETA
Middle Name:PAULETTE
Last Name:CHANG
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 1:4533 DALLAS PL APT T2
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3325
Mailing Address - Country:US
Mailing Address - Phone:240-707-4265
Mailing Address - Fax:
Practice Address - Street 1:2515 R ST SE APT 326
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3970
Practice Address - Country:US
Practice Address - Phone:202-575-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant