Healthcare Provider Details

I. General information

NPI: 1710701651
Provider Name (Legal Business Name): EMILIE ANDIN ENJEMA TENGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11233 WHEELER RIDGE DR
MANASSAS VA
20109-5721
US

IV. Provider business mailing address

3331 BUCHANAN ST APT 103
MOUNT RAINIER MD
20712-1120
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-5099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200004707
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: