Organization
GAMBRILLS SISTERS HEALTH CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATU N/A KOROMA DNP (OWNER)
(240) 437-2705
Entity
Organization
Contact information
Practice address
2920 N 24TH AVE, PHOENIX, AZ 85015-5947
(240) 437-2705
Mailing address
106 CALUMET CT, GAMBRILLS, MD 21054-1060
(240) 437-2705
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/03/2023
Last updated
05/03/2023
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