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General NPI Number Information
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NPI Number | 1912599317
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Entity Type | Individual
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Provider Name | FANTA BOMPORO KOROMA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2021
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 9522 MUIRKIRK RD APT 301
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City | LAUREL
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State | MD
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Zip | 20708-2736
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Country | US
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Telephone | 240-485-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 9522 MUIRKIRK RD APT 301
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City | LAUREL
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State | MD
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Zip | 20708-2736
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Country | US
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Telephone | 240-485-7735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA200005664
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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