Provider Demographics
NPI:1992328082
Name:FENNELL, TENAYA NIKARA
Entity type:Individual
Prefix:
First Name:TENAYA
Middle Name:NIKARA
Last Name:FENNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TENAYA
Other - Middle Name:NIKARA
Other - Last Name:FENNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2406 MOROCCO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0945
Mailing Address - Country:US
Mailing Address - Phone:702-927-5085
Mailing Address - Fax:
Practice Address - Street 1:2406 MOROCCO AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0945
Practice Address - Country:US
Practice Address - Phone:702-927-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide