Provider Demographics
NPI:1700141199
Name:ANYIZI-TAKU, URSLA
Entity Type:Individual
Prefix:
First Name:URSLA
Middle Name:
Last Name:ANYIZI-TAKU
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 1:5040 NEW HAMPSHIRE AVE
Mailing Address - Street 2:103
Mailing Address - City:WASHNIGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:240-601-0721
Mailing Address - Fax:
Practice Address - Street 1:5040 NEW HAMPSHIRE AVE
Practice Address - Street 2:103
Practice Address - City:WASHNIGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:240-601-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide