Provider Demographics
NPI:1174277834
Name:TOLEFAC ANYIACHA, VICTORINE
Entity Type:Individual
Prefix:
First Name:VICTORINE
Middle Name:
Last Name:TOLEFAC ANYIACHA
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 1:2506 QUEENS CHAPEL RD APT 102
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3647
Mailing Address - Country:US
Mailing Address - Phone:202-940-3606
Mailing Address - Fax:
Practice Address - Street 1:2506 QUEENS CHAPEL RD APT 102
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3647
Practice Address - Country:US
Practice Address - Phone:202-940-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00199597374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide