Provider Demographics
NPI:1841903135
Name:TENA, MADELINE MICHELLE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:MICHELLE
Last Name:TENA
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 1:625 NW 5TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6447
Mailing Address - Country:US
Mailing Address - Phone:206-854-0491
Mailing Address - Fax:
Practice Address - Street 1:625 NW 5TH ST APT 5
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6447
Practice Address - Country:US
Practice Address - Phone:206-854-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program