Healthcare Provider Details

I. General information

NPI: 1992669949
Provider Name (Legal Business Name): ERNEST FOMUNUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 ALTHORP PL
LIBERTY TOWNSHIP OH
45044-3322
US

IV. Provider business mailing address

5040 ALTHORP PL
LIBERTY TOWNSHIP OH
45044-3322
US

V. Phone/Fax

Practice location:
  • Phone: 513-765-0069
  • Fax:
Mailing address:
  • Phone: 513-765-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number5303405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: