Provider Demographics
NPI:1396563839
Name:TAKOH, BRENDA M
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:TAKOH
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 1:3004 EWELL LN
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1961
Mailing Address - Country:US
Mailing Address - Phone:240-761-1623
Mailing Address - Fax:
Practice Address - Street 1:4650 ADDISON RD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1003
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00216962376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide