Provider Demographics
NPI:1679833271
Name:SENTEW CARE NURSE PRACTITIONER LLC
Entity Type:Organization
Organization Name:SENTEW CARE NURSE PRACTITIONER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SENAIT
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWOLDE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:202-670-2570
Mailing Address - Street 1:8322 BARK TREE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3828
Mailing Address - Country:US
Mailing Address - Phone:202-670-2570
Mailing Address - Fax:202-800-2845
Practice Address - Street 1:8322 BARK TREE CT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-3828
Practice Address - Country:US
Practice Address - Phone:202-670-2570
Practice Address - Fax:202-800-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1003185363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty