Provider Demographics
NPI:1336631886
Name:NINAN, ANISHA CHAKKACHERIL (CRNP)
Entity Type:Individual
Prefix:
First Name:ANISHA
Middle Name:CHAKKACHERIL
Last Name:NINAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANISHA
Other - Middle Name:
Other - Last Name:CHAKKACHERIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:600 N. WOLFE STREET
Practice Address - Street 2:OSLER 600
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-5353
Practice Address - Fax:410-502-3831
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX862730363LF0000X
MDR235759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily