Provider Demographics
NPI:1255170379
Name:TENA, ZEMZEM M
Entity type:Individual
Prefix:
First Name:ZEMZEM
Middle Name:M
Last Name:TENA
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 1:6615 BLUESTEM LN S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4486
Mailing Address - Country:US
Mailing Address - Phone:651-434-5530
Mailing Address - Fax:
Practice Address - Street 1:6615 BLUESTEM LN S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4486
Practice Address - Country:US
Practice Address - Phone:651-434-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1118375253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency