Provider Demographics
NPI:1063096964
Name:KADJI-TEDJEU, ALINE ANTOINETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALINE
Middle Name:ANTOINETTE
Last Name:KADJI-TEDJEU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12642 TRAVILAH RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1084
Mailing Address - Country:US
Mailing Address - Phone:703-785-2175
Mailing Address - Fax:
Practice Address - Street 1:10810 DARNESTOWN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2675
Practice Address - Country:US
Practice Address - Phone:301-257-6133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner