Provider Demographics
NPI:1578815866
Name:NDIFORMUTIEH, VICTORINE P
Entity Type:Individual
Prefix:MRS
First Name:VICTORINE
Middle Name:P
Last Name:NDIFORMUTIEH
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 1:6110 BREEZEWOOD DR APT 303
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4150
Mailing Address - Country:US
Mailing Address - Phone:240-551-4180
Mailing Address - Fax:
Practice Address - Street 1:6110 BREEZEWOOD DR APT 303
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4150
Practice Address - Country:US
Practice Address - Phone:240-551-4180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide