Provider Demographics
NPI:1023769866
Name:KOROMA, FATMATA
Entity type:Individual
Prefix:
First Name:FATMATA
Middle Name:
Last Name:KOROMA
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 1:3905 NORWALK PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1047
Mailing Address - Country:US
Mailing Address - Phone:301-503-4938
Mailing Address - Fax:
Practice Address - Street 1:3905 NORWALK PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1047
Practice Address - Country:US
Practice Address - Phone:301-503-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse