Provider Demographics
NPI:1093405904
Name:FORTEN HONORINE ANYIZIE, FNU
Entity Type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:FORTEN HONORINE ANYIZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 MANTON WAY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2488
Mailing Address - Country:US
Mailing Address - Phone:240-432-3399
Mailing Address - Fax:
Practice Address - Street 1:6505 MANTON WAY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2488
Practice Address - Country:US
Practice Address - Phone:240-432-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide