Provider Demographics
NPI:1063183176
Name:SANSBURY, TOWANNA
Entity type:Individual
Prefix:MRS
First Name:TOWANNA
Middle Name:
Last Name:SANSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TOWANNA
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2413 FAIRLAWN ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-3017
Mailing Address - Country:US
Mailing Address - Phone:301-248-6267
Mailing Address - Fax:
Practice Address - Street 1:2413 FAIRLAWN ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-3017
Practice Address - Country:US
Practice Address - Phone:301-248-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider