Provider Demographics
NPI:1811570815
Name:KANU, ANTONETTE SALLAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:SALLAY
Last Name:KANU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S CHERRY GROVE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4235
Mailing Address - Country:US
Mailing Address - Phone:844-322-4222
Mailing Address - Fax:443-400-0509
Practice Address - Street 1:509 S CHERRY GROVE AVE STE C
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4235
Practice Address - Country:US
Practice Address - Phone:844-322-4222
Practice Address - Fax:443-400-0509
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020092732OtherFNP-BC
MDR208761OtherCRNP-FAMILY