MEDICARE: YVONNE TCHOUSSOM FANSI FANSI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA200001477	DC

General Provider Information

NPI Number	:	1124605639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE TCHOUSSOM FANSI FANSI

Provider Business Mailing Address
First Line	:	8830 PINEY BRANCH RD APT 503
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-3512
Country	:	US
Telephone Number	:	202-848-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 SOUTHVIEW AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5637
Country	:	US
Telephone Number	:	202-848-2546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	06/04/2026

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