Provider Demographics
NPI:1912304593
Name:CHINTANKWA, TENISHIA (NON EMERGENCY TRANSP)
Entity Type:Individual
Prefix:
First Name:TENISHIA
Middle Name:
Last Name:CHINTANKWA
Suffix:
Gender:F
Credentials:NON EMERGENCY TRANSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 DOREEN ST
Mailing Address - Street 2:DOREEN ST.
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-4911
Mailing Address - Country:US
Mailing Address - Phone:817-484-8774
Mailing Address - Fax:972-639-3263
Practice Address - Street 1:2403 DOREEN ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:817-484-8774
Practice Address - Fax:972-639-3263
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)