Provider Demographics
NPI:1063172518
Name:FATOMA, BRITTANY ELISE (CD)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ELISE
Last Name:FATOMA
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BROADWAY VILLAGE DR APT G
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8646
Mailing Address - Country:US
Mailing Address - Phone:857-753-5504
Mailing Address - Fax:
Practice Address - Street 1:16 BROADWAY VILLAGE DR APT G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8646
Practice Address - Country:US
Practice Address - Phone:857-753-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-26
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty