Provider Demographics
NPI:1427602150
Name:FORNAH, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FORNAH
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 1:5711 SARVIS AVE STE 608
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1394
Mailing Address - Country:US
Mailing Address - Phone:301-277-4337
Mailing Address - Fax:
Practice Address - Street 1:5711 SARVIS AVE STE 608
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1394
Practice Address - Country:US
Practice Address - Phone:301-277-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002096817164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse