Provider Demographics
NPI:1720714215
Name:TENAW, NARDOS
Entity type:Individual
Prefix:
First Name:NARDOS
Middle Name:
Last Name:TENAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3075
Mailing Address - Country:US
Mailing Address - Phone:301-755-7961
Mailing Address - Fax:833-428-8384
Practice Address - Street 1:7110 HERITAGE VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3075
Practice Address - Country:US
Practice Address - Phone:571-556-8205
Practice Address - Fax:833-428-8384
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT500-622-027-288163W00000X
VA0024191812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse