Provider Demographics
NPI:1902479397
Name:TENNER, BOBBY LEE SR
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEE
Last Name:TENNER
Suffix:SR
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 1:3700 9TH ST SE APT 125
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4009
Mailing Address - Country:US
Mailing Address - Phone:202-910-2840
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 125
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4009
Practice Address - Country:US
Practice Address - Phone:202-910-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant