Provider Demographics
NPI:1346064714
Name:SAM, TENAJE (MA-P)
Entity type:Individual
Prefix:
First Name:TENAJE
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:MA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3831
Mailing Address - Country:US
Mailing Address - Phone:253-973-1623
Mailing Address - Fax:
Practice Address - Street 1:2341 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3831
Practice Address - Country:US
Practice Address - Phone:253-973-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC60635715246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy