Provider Demographics
NPI:1639552540
Name:ATECHONG, THERESIA AJENANYI (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:AJENANYI
Last Name:ATECHONG
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:THERESIA
Other - Middle Name:
Other - Last Name:ATECHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HOME HEALTH AIDE
Mailing Address - Street 1:13518 GREENCASTLE RIDGE TER APT 402
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2153
Mailing Address - Country:US
Mailing Address - Phone:240-646-2115
Mailing Address - Fax:
Practice Address - Street 1:13518 GREENCASTLE RIDGE TER APT 402
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866
Practice Address - Country:US
Practice Address - Phone:240-646-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11413374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide