Provider Demographics
NPI:1275346603
Name:TEGANTVOORT, CAREN
Entity type:Individual
Prefix:
First Name:CAREN
Middle Name:
Last Name:TEGANTVOORT
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 1:819 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89460-6541
Mailing Address - Country:US
Mailing Address - Phone:702-357-8317
Mailing Address - Fax:702-357-8317
Practice Address - Street 1:819 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89460-6541
Practice Address - Country:US
Practice Address - Phone:702-357-8317
Practice Address - Fax:702-357-8317
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant