Provider Demographics
NPI:1649022336
Name:FOMUNUNG, REGINA KAHNDENMUN
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:KAHNDENMUN
Last Name:FOMUNUNG
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 1:13105 MUSICMASTER DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6806
Mailing Address - Country:US
Mailing Address - Phone:727-902-7248
Mailing Address - Fax:
Practice Address - Street 1:13105 MUSICMASTER DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6806
Practice Address - Country:US
Practice Address - Phone:727-902-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide