Healthcare Provider Details

I. General information

NPI: 1932062858
Provider Name (Legal Business Name): FRANCIS KOROMA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HAWA KOROMA FORNAH

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 PRUETT CT
GLEN ALLEN VA
23059
US

IV. Provider business mailing address

2004 PRUETT CT
GLEN ALLEN VA
23059-8035
US

V. Phone/Fax

Practice location:
  • Phone: 804-852-7378
  • Fax:
Mailing address:
  • Phone: 804-852-7378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number11915649
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: