Healthcare Provider Details

I. General information

NPI: 1194652040
Provider Name (Legal Business Name): NAHVOMA FONBISA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CRAIN HWY S
GLEN BURNIE MD
21061-4058
US

IV. Provider business mailing address

512 JENNINGS MILL DR
BOWIE MD
20721-7240
US

V. Phone/Fax

Practice location:
  • Phone: 240-481-8451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR239337
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: