Healthcare Provider Details

I. General information

NPI: 1881507747
Provider Name (Legal Business Name): TENAGNE LAKEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 STULTS RD
DAYTON NJ
08810-2514
US

IV. Provider business mailing address

15 RUNYON ST
HILLSBOROUGH NJ
08844-5296
US

V. Phone/Fax

Practice location:
  • Phone: 848-200-1699
  • Fax:
Mailing address:
  • Phone: 908-963-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15664800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: