Provider Demographics
NPI:1114326147
Name:KANU, KADAY SUSAN I (NURSE)
Entity Type:Individual
Prefix:MISS
First Name:KADAY
Middle Name:SUSAN
Last Name:KANU
Suffix:I
Gender:F
Credentials:NURSE
Other - Prefix:MISS
Other - First Name:KADAY
Other - Middle Name:SUSAN
Other - Last Name:KANU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE
Mailing Address - Street 1:6706 LONGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3741
Mailing Address - Country:US
Mailing Address - Phone:240-704-5574
Mailing Address - Fax:
Practice Address - Street 1:6706 LONGRIDGE DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3741
Practice Address - Country:US
Practice Address - Phone:240-704-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA00803248376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide