Healthcare Provider Details

I. General information

NPI: 1760137541
Provider Name (Legal Business Name): JOSEPH TEKE TENGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2022
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 BRAE BROOKE DR
LANHAM MD
20706-3387
US

IV. Provider business mailing address

9010 BRAE BROOKE DR
LANHAM MD
20706-3387
US

V. Phone/Fax

Practice location:
  • Phone: 240-825-8492
  • Fax:
Mailing address:
  • Phone: 240-825-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA20220033
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberCNA20220033
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: