Provider Demographics
NPI:1225377583
Name:FASAN, TAWA Y (HHA)
Entity Type:Individual
Prefix:
First Name:TAWA
Middle Name:Y
Last Name:FASAN
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 WHITFIELD CHAPEL RD APT 302
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2556
Mailing Address - Country:US
Mailing Address - Phone:301-437-6318
Mailing Address - Fax:
Practice Address - Street 1:5636 WHITFIELD CHAPEL RD APT 302
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2556
Practice Address - Country:US
Practice Address - Phone:301-437-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide