| NPI | 1558951285 |
|---|---|
| Former Name | ANCELLA W. FOMINYAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1035937) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1035937) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-10-12 |