MEDICARE: KUMBA PRISCILLA TORMUSA-KOROMA

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	163WP0200X	Pediatric Registered Nurse	759326	TX

General Provider Information

NPI Number	:	1386100881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUMBA PRISCILLA TORMUSA-KOROMA

Provider Business Mailing Address
First Line	:	6918 ITHACA HEIGHTS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2320
Country	:	US
Telephone Number	:	832-677-2747
Fax Number	:

Provider Business Practice Location Address
First Line	:	6918 ITHACA HEIGHTS LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2320
Country	:	US
Telephone Number	:	832-677-2747
Fax Number	:

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

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/20/2019

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