Provider Demographics
NPI:1598463796
Name:MOSA, FATUMA ESSA
Entity Type:Individual
Prefix:
First Name:FATUMA
Middle Name:ESSA
Last Name:MOSA
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 1:10903 NEW SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2308
Mailing Address - Country:US
Mailing Address - Phone:202-655-9786
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW SALEM AVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2308
Practice Address - Country:US
Practice Address - Phone:202-655-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00182656374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide