Provider Demographics
NPI:1790254423
Name:TANJECK, RACHEL EMA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:EMA
Last Name:TANJECK
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 1:4201 58TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1912
Mailing Address - Country:US
Mailing Address - Phone:301-682-1199
Mailing Address - Fax:
Practice Address - Street 1:4201 58TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1912
Practice Address - Country:US
Practice Address - Phone:301-682-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13789374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide