Provider Demographics
NPI:1740822865
Name:FONJONG, VIVIEN ANJOH (FNP)
Entity type:Individual
Prefix:MS
First Name:VIVIEN
Middle Name:ANJOH
Last Name:FONJONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VIVIEN
Other - Middle Name:ANJOH
Other - Last Name:FONJONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:9710 PATUXENT WOODS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3458
Mailing Address - Country:US
Mailing Address - Phone:443-899-9525
Mailing Address - Fax:
Practice Address - Street 1:9710 PATUXENT WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3458
Practice Address - Country:US
Practice Address - Phone:443-899-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCRNP134269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily