Provider Demographics
NPI:1891510145
Name:LINEH, CANELIA FOMUSOH
Entity type:Individual
Prefix:
First Name:CANELIA
Middle Name:FOMUSOH
Last Name:LINEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405C 46TH AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2415
Mailing Address - Country:US
Mailing Address - Phone:202-557-9163
Mailing Address - Fax:
Practice Address - Street 1:10405C 46TH AVE APT 303
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2415
Practice Address - Country:US
Practice Address - Phone:202-557-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide