Provider Demographics
NPI:1336400571
Name:FOMUNYOH, GIDEON (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:GIDEON
Middle Name:
Last Name:FOMUNYOH
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:GIDEON
Other - Middle Name:
Other - Last Name:FOMUMYOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6110 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1204
Mailing Address - Country:US
Mailing Address - Phone:608-213-6116
Mailing Address - Fax:
Practice Address - Street 1:6110 7TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1204
Practice Address - Country:US
Practice Address - Phone:608-213-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide