Provider Demographics
NPI:1053674473
Name:FYNEWOOD, CHIOMA OSISIOMA
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:OSISIOMA
Last Name:FYNEWOOD
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 1:14406 WOODMORE OAKS CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3012
Mailing Address - Country:US
Mailing Address - Phone:202-509-4383
Mailing Address - Fax:
Practice Address - Street 1:14406 WOODMORE OAKS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3012
Practice Address - Country:US
Practice Address - Phone:202-509-4383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program