Provider Demographics
NPI:1346554995
Name:ANUOLAM, VIVIAN T
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:T
Last Name:ANUOLAM
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 1:13335 FALL MANOR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2431
Mailing Address - Country:US
Mailing Address - Phone:469-337-3822
Mailing Address - Fax:
Practice Address - Street 1:13335 FALL MANOR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2431
Practice Address - Country:US
Practice Address - Phone:469-337-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker