=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386637098
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS E TINDONG PMHNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2005
-----------------------------------------------------
Last Update Date | 05/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7404 EXECUTIVE PL STE 100
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-260-3827
-----------------------------------------------------
Fax | 240-260-3830
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3613 CELESTE BRUCE CIR
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-2287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-260-3827
-----------------------------------------------------
Fax | 240-260-3830
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN305565
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | R180878
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------