Provider Demographics
NPI:1821658261
Name:TENDOH, FRISTA AKO
Entity Type:Individual
Prefix:
First Name:FRISTA
Middle Name:AKO
Last Name:TENDOH
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 1:2510 QUEENS CHAPEL RD APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3649
Mailing Address - Country:US
Mailing Address - Phone:937-329-3645
Mailing Address - Fax:
Practice Address - Street 1:2510 QUEENS CHAPEL RD APT 103
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3649
Practice Address - Country:US
Practice Address - Phone:937-329-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14478374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide