Provider Demographics
NPI:1952547911
Name:OMERENNAH, FLORENCE IFEOMA (RD LD/N)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:IFEOMA
Last Name:OMERENNAH
Suffix:
Gender:F
Credentials:RD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SETTLERS WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5770
Mailing Address - Country:US
Mailing Address - Phone:301-341-4680
Mailing Address - Fax:
Practice Address - Street 1:1300 MERCANTILE LN STE 129-37
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-341-4680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX2507133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered