Provider Demographics
NPI:1740940964
Name:KANAKOR, NUKOLAH
Entity type:Individual
Prefix:
First Name:NUKOLAH
Middle Name:
Last Name:KANAKOR
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 1:3 OSGOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01850-1116
Mailing Address - Country:US
Mailing Address - Phone:978-349-8302
Mailing Address - Fax:
Practice Address - Street 1:3 OSGOOD AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01850-1116
Practice Address - Country:US
Practice Address - Phone:978-349-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACNA51645376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty