Provider Demographics
NPI:1831815919
Name:NYASA, PHILOMINA
Entity type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:
Last Name:NYASA
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 1:5203 JANESDALE CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2307
Mailing Address - Country:US
Mailing Address - Phone:202-544-8090
Mailing Address - Fax:
Practice Address - Street 1:5203 JANESDALE CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2307
Practice Address - Country:US
Practice Address - Phone:202-544-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide