Provider Demographics
NPI:1285228452
Name:KOROMA, FATIMA MUNA (NP)
Entity Type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:MUNA
Last Name:KOROMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ROCHELLE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5632
Mailing Address - Country:US
Mailing Address - Phone:571-277-1111
Mailing Address - Fax:
Practice Address - Street 1:1805 ROCHELLE CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5632
Practice Address - Country:US
Practice Address - Phone:301-265-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181302363LP0808X
MDAC003679363LP0808X
DCRN1063431363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC88-4380516OtherIRS
MD88-3457287OtherIRS