Provider Demographics
NPI:1598304891
Name:FOMBA, JANNET KORLEH
Entity Type:Individual
Prefix:
First Name:JANNET
Middle Name:KORLEH
Last Name:FOMBA
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 1:8309 CARROLLTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3404
Mailing Address - Country:US
Mailing Address - Phone:240-467-8051
Mailing Address - Fax:
Practice Address - Street 1:8309 CARROLLTON PKWY
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3404
Practice Address - Country:US
Practice Address - Phone:240-467-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide