Provider Demographics
NPI:1558999375
Name:FORNAH, HAWA
Entity Type:Individual
Prefix:
First Name:HAWA
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 1:15104 DENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3257
Mailing Address - Country:US
Mailing Address - Phone:240-280-9360
Mailing Address - Fax:
Practice Address - Street 1:15104 DENNINGTON DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3257
Practice Address - Country:US
Practice Address - Phone:240-280-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
MDF-6502980238573747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant