Provider Demographics
NPI:1174962484
Name:JIBODU, FUMI B
Entity type:Individual
Prefix:
First Name:FUMI
Middle Name:B
Last Name:JIBODU
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 1:3900 GREENCASTLE RIDGE DR
Mailing Address - Street 2:APT 301
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-2118
Mailing Address - Country:US
Mailing Address - Phone:301-364-8553
Mailing Address - Fax:
Practice Address - Street 1:3900 GREENCASTLE RIDGE DR
Practice Address - Street 2:APT 301
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-2118
Practice Address - Country:US
Practice Address - Phone:301-364-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7178374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide