MEDICARE: CHIOMA OSISIOMA FYNEWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		DC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1053674473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIOMA OSISIOMA FYNEWOOD

Provider Business Mailing Address
First Line	:	14406 WOODMORE OAKS CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-3012
Country	:	US
Telephone Number	:	202-509-4383
Fax Number	:

Provider Business Practice Location Address
First Line	:	14406 WOODMORE OAKS CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-3012
Country	:	US
Telephone Number	:	202-509-4383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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