Provider Demographics
NPI:1457887176
Name:FOMBU, JULIET SWIRRI
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:SWIRRI
Last Name:FOMBU
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 1:2612 BROOKE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1887
Mailing Address - Country:US
Mailing Address - Phone:240-516-4329
Mailing Address - Fax:
Practice Address - Street 1:920 BELLEVUE ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-6030
Practice Address - Country:US
Practice Address - Phone:202-516-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1060186163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty