Provider Demographics
NPI:1124605639
Name:FANSI FANSI, YVONNE TCHOUSSOM
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:TCHOUSSOM
Last Name:FANSI FANSI
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 1:309 SOUTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5637
Mailing Address - Country:US
Mailing Address - Phone:202-848-2546
Mailing Address - Fax:
Practice Address - Street 1:309 SOUTHVIEW AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-5637
Practice Address - Country:US
Practice Address - Phone:202-848-2546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide