Healthcare Provider Details

I. General information

NPI: 1154858835
Provider Name (Legal Business Name): MS. ROSELINE CHINYERE OMULAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 LEMONTREE TER
SPRINGDALE MD
20774-7540
US

IV. Provider business mailing address

2503 LEMONTREE TER
SPRINGDALE MD
20774-7540
US

V. Phone/Fax

Practice location:
  • Phone: 202-617-8881
  • Fax:
Mailing address:
  • Phone: 202-617-8881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12739
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: