Provider Demographics
NPI:1891058913
Name:KANU, ISATU TATA
Entity Type:Individual
Prefix:
First Name:ISATU
Middle Name:TATA
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 1:9609 DAPPER TOWN ROW
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-5882
Mailing Address - Country:US
Mailing Address - Phone:202-281-5205
Mailing Address - Fax:202-281-5205
Practice Address - Street 1:9609 DAPPER TOWN ROW
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5882
Practice Address - Country:US
Practice Address - Phone:202-281-5205
Practice Address - Fax:202-281-5205
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1041869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse