Provider Demographics
NPI:1891058756
Name:TAPANG FUKO, COLETTE
Entity Type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:
Last Name:TAPANG FUKO
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 1:2512 QUEENS CHAPEL RD # APPT104
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3650
Mailing Address - Country:US
Mailing Address - Phone:918-814-1997
Mailing Address - Fax:
Practice Address - Street 1:2512 QUEENS CHAPEL RD # APPT104
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3650
Practice Address - Country:US
Practice Address - Phone:918-814-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health