Provider Demographics
NPI:1063044279
Name:KAKANOU, NADINE G (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:G
Last Name:KAKANOU
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14760 MCKNEW RD
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1358
Mailing Address - Country:US
Mailing Address - Phone:301-536-0615
Mailing Address - Fax:
Practice Address - Street 1:14760 MCKNEW RD
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1358
Practice Address - Country:US
Practice Address - Phone:301-536-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206958363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health