Provider Demographics
NPI:1720714215
Name:TENAW, NARDOS
Entity Type:Individual
Prefix:
First Name:NARDOS
Middle Name:
Last Name:TENAW
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 1:8530 FOUNTAIN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5671
Mailing Address - Country:US
Mailing Address - Phone:301-755-7961
Mailing Address - Fax:
Practice Address - Street 1:8530 FOUNTAIN VALLEY DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-5671
Practice Address - Country:US
Practice Address - Phone:301-755-7961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT500-622-027-288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse