Provider Demographics
NPI:1780982066
Name:KOROMA, DEBORAH (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KOROMA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16204 PENTERRA WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1919
Mailing Address - Country:US
Mailing Address - Phone:240-432-1313
Mailing Address - Fax:
Practice Address - Street 1:8700 CENTRAL AVE STE 302A
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4853
Practice Address - Country:US
Practice Address - Phone:301-613-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR192395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily