Provider Demographics
NPI:1235863036
Name:NANI TOMI, ROSALINE
Entity Type:Individual
Prefix:
First Name:ROSALINE
Middle Name:
Last Name:NANI TOMI
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 1:12140 KOUSA CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-8651
Mailing Address - Country:US
Mailing Address - Phone:571-201-3605
Mailing Address - Fax:
Practice Address - Street 1:12140 KOUSA CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8651
Practice Address - Country:US
Practice Address - Phone:571-201-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA10934729343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)