Provider Demographics
NPI:1497235394
Name:KANU, HASSAN HAWA
Entity Type:Individual
Prefix:
First Name:HASSAN
Middle Name:HAWA
Last Name:KANU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2816
Mailing Address - Country:US
Mailing Address - Phone:215-921-9200
Mailing Address - Fax:215-921-9727
Practice Address - Street 1:6509 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2816
Practice Address - Country:US
Practice Address - Phone:215-921-9200
Practice Address - Fax:215-921-9727
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN283850164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty