Provider Demographics
NPI:1760137541
Name:TENGEN, JOSEPH TEKE
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TEKE
Last Name:TENGEN
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 1:2512 QUEENS CHAPEL RD APT 2
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3650
Mailing Address - Country:US
Mailing Address - Phone:240-825-8492
Mailing Address - Fax:
Practice Address - Street 1:2512 QUEENS CHAPEL RD APT 2
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3650
Practice Address - Country:US
Practice Address - Phone:240-825-8492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20220033376K00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No164X00000XNursing Service ProvidersLicensed Vocational Nurse