Provider Demographics
NPI:1154688638
Name:FOMENKY, MIRABEL
Entity Type:Individual
Prefix:
First Name:MIRABEL
Middle Name:
Last Name:FOMENKY
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 1:5993 SPRINGHILL DR
Mailing Address - Street 2:APT#304
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5993 SPRINGHILL DR
Practice Address - Street 2:APT#304
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3110
Practice Address - Country:US
Practice Address - Phone:202-722-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide