Provider Demographics
NPI:1851780910
Name:POPOOLA, SAMMIE FISHERS
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:FISHERS
Last Name:POPOOLA
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 1:3693 JAY ST NE
Mailing Address - Street 2:APT 101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1758
Mailing Address - Country:US
Mailing Address - Phone:202-492-0869
Mailing Address - Fax:
Practice Address - Street 1:3693 JAY ST NE
Practice Address - Street 2:APT 101
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1758
Practice Address - Country:US
Practice Address - Phone:202-492-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9793374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide