MEDICARE: ANANGA ISAAC FOMINYAM

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	163W00000X	Registered Nurse	186626	MD

General Provider Information

NPI Number	:	1831046796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANANGA ISAAC FOMINYAM

Provider Business Mailing Address
First Line	:	4806 WILLES VISION DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4671
Country	:	US
Telephone Number	:	512-797-4871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4806 WILLES VISION DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4671
Country	:	US
Telephone Number	:	512-797-4871
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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