Provider Demographics
NPI:1740731165
Name:TIENTCHEU, SERGES B (CNA)
Entity type:Individual
Prefix:
First Name:SERGES
Middle Name:B
Last Name:TIENTCHEU
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 WOODBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3425
Mailing Address - Country:US
Mailing Address - Phone:301-277-4337
Mailing Address - Fax:301-277-4335
Practice Address - Street 1:9414 WOODBERRY ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3425
Practice Address - Country:US
Practice Address - Phone:301-277-4337
Practice Address - Fax:301-277-4335
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA201639313747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant