Provider Demographics
NPI:1700144672
Name:FORTUCHANG, ANYIKIA F
Entity type:Individual
Prefix:
First Name:ANYIKIA
Middle Name:F
Last Name:FORTUCHANG
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 1:7711 RIVERDALE RD APT 203
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3940
Mailing Address - Country:US
Mailing Address - Phone:240-640-0519
Mailing Address - Fax:
Practice Address - Street 1:7711 RIVERDALE RD APT 203
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3940
Practice Address - Country:US
Practice Address - Phone:240-640-0519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide