Individual
ODETTE NGUM FOMINYAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4806 WILLES VISION DR, BOWIE, MD 20720-4671
(240) 616-8239
Mailing address
4806 WILLES VISION DR, BOWIE, MD 20720-4671
(240) 616-8239
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
374U00000X
Home Health Aide
HHA14118
DC
Other
Enumeration date
11/28/2018
Last updated
07/25/2023
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