Provider Demographics
NPI:1154832186
Name:KANU, MEMANATU
Entity Type:Individual
Prefix:
First Name:MEMANATU
Middle Name:
Last Name:KANU
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 1:4600 POWDER MILL RD STE 450V
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2675
Mailing Address - Country:US
Mailing Address - Phone:301-586-2230
Mailing Address - Fax:240-524-1374
Practice Address - Street 1:4600 POWDER MILL RD STE 450V
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2675
Practice Address - Country:US
Practice Address - Phone:301-586-2230
Practice Address - Fax:240-524-1374
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse