Provider Demographics
NPI:1720625221
Name:TEJAN, NASIRU
Entity type:Individual
Prefix:
First Name:NASIRU
Middle Name:
Last Name:TEJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 RICHENBACHER AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2053
Mailing Address - Country:US
Mailing Address - Phone:571-489-3257
Mailing Address - Fax:
Practice Address - Street 1:5402 RICHENBACHER AVE APT 301
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2053
Practice Address - Country:US
Practice Address - Phone:571-489-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty