Provider Demographics
NPI:1932672847
Name:TAZOH, ANITA M
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:TAZOH
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 1:9823 GOOD LUCK RD APT 6
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3363
Mailing Address - Country:US
Mailing Address - Phone:202-766-8475
Mailing Address - Fax:
Practice Address - Street 1:9823 GOOD LUCK RD APT 6
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3363
Practice Address - Country:US
Practice Address - Phone:202-766-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14225374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide