Provider Demographics
NPI:1740636380
Name:KANU, MIRIAM M (CNA)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:M
Last Name:KANU
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 CORPORATE DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2230
Mailing Address - Country:US
Mailing Address - Phone:301-760-3350
Mailing Address - Fax:301-760-3348
Practice Address - Street 1:8201 CORPORATE DR
Practice Address - Street 2:SUITE 700
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2230
Practice Address - Country:US
Practice Address - Phone:301-760-3350
Practice Address - Fax:301-760-3348
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00024542251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health