Healthcare Provider Details

I. General information

NPI: 1316738099
Provider Name (Legal Business Name): BRINET TETUH GWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 MARLENE DR
LANHAM MD
20706-1974
US

IV. Provider business mailing address

5403 MARLENE DR
LANHAM MD
20706-1974
US

V. Phone/Fax

Practice location:
  • Phone: 240-791-2364
  • Fax:
Mailing address:
  • Phone: 240-791-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: