Provider Demographics
NPI:1932464872
Name:AMBOMU, ANNI M (HHA)
Entity Type:Individual
Prefix:
First Name:ANNI
Middle Name:M
Last Name:AMBOMU
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 GEORGIA AVE NW
Mailing Address - Street 2:SUITE 323
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1616
Mailing Address - Country:US
Mailing Address - Phone:202-723-3060
Mailing Address - Fax:202-723-3065
Practice Address - Street 1:7600 GEORGIA AVE NW
Practice Address - Street 2:SUITE 323
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1616
Practice Address - Country:US
Practice Address - Phone:202-723-3060
Practice Address - Fax:202-723-3065
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA1729374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide