Individual
CLARIS KININLA FONBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
901 1ST ST NW, WASHINGTON, DC 20001-1403
(202) 282-3100
Mailing address
10424 FLORAL DR, ADELPHI, MD 20783-1226
(240) 534-8066
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA13808
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WVO16208349W
BLUECROSS BLUESHIELD
AR
01
—
WVO16208349W
BLUECROSS BLUESHIELD
—
Enumeration date
07/29/2018
Last updated
07/29/2018
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