Provider Demographics
NPI:1699254748
Name:TALOM, VIVIANE FOFIE FOPA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:VIVIANE
Middle Name:FOFIE FOPA
Last Name:TALOM
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 AFTON FOREST LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4766
Mailing Address - Country:US
Mailing Address - Phone:832-871-6442
Mailing Address - Fax:
Practice Address - Street 1:3418 AFTON FOREST LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4766
Practice Address - Country:US
Practice Address - Phone:832-871-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX895224163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health