Provider Demographics
NPI:1689933202
Name:FOMBONG, KAREN AKOM
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:AKOM
Last Name:FOMBONG
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 1:3300 E WEST HWY
Mailing Address - Street 2:APT 442
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2176
Mailing Address - Country:US
Mailing Address - Phone:301-803-8033
Mailing Address - Fax:
Practice Address - Street 1:3300 E WEST HWY
Practice Address - Street 2:APT 442
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2176
Practice Address - Country:US
Practice Address - Phone:301-803-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA-250-258-461-242374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide