| NPI | 1245828383 |
|---|---|
| Other Name | MARY ANNE FOMBU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA F05210644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60860845) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2024-05-08 |