Provider Demographics
NPI:1629727730
Name:TAZISONG, RENIE EFUETNGU LEKE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RENIE
Middle Name:EFUETNGU LEKE
Last Name:TAZISONG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5609 PINE BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-6894
Mailing Address - Country:US
Mailing Address - Phone:240-728-5997
Mailing Address - Fax:
Practice Address - Street 1:7067 COLUMBIA GATEWAY DR STE 180
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3408
Practice Address - Country:US
Practice Address - Phone:410-929-7225
Practice Address - Fax:443-333-5434
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC004226163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health