Provider Demographics
NPI:1659763803
Name:KENAW, FANAYE
Entity Type:Individual
Prefix:
First Name:FANAYE
Middle Name:
Last Name:KENAW
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 1:5929 QUANTRELL AVE
Mailing Address - Street 2:APT. 104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2725
Mailing Address - Country:US
Mailing Address - Phone:202-468-0895
Mailing Address - Fax:
Practice Address - Street 1:5929 QUANTRELL AVE
Practice Address - Street 2:APT. 104
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2725
Practice Address - Country:US
Practice Address - Phone:202-468-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11006374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide