Provider Demographics
NPI:1235930512
Name:YVETTE, ANCHIMBOM
Entity type:Individual
Prefix:
First Name:ANCHIMBOM
Middle Name:
Last Name:YVETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 LORY LN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1114
Mailing Address - Country:US
Mailing Address - Phone:757-917-8564
Mailing Address - Fax:
Practice Address - Street 1:2478 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2739
Practice Address - Country:US
Practice Address - Phone:757-917-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator