Provider Demographics
NPI:1376128421
Name:FUANJIA, COLIN ANU
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:ANU
Last Name:FUANJIA
Suffix:
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 1:9857 GOOD LUCK RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3222
Mailing Address - Country:US
Mailing Address - Phone:240-524-1472
Mailing Address - Fax:
Practice Address - Street 1:9857 GOOD LUCK RD APT 6
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3222
Practice Address - Country:US
Practice Address - Phone:240-524-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide