Provider Demographics
NPI:1932865896
Name:KAMSU NASAH, EBAI HELENE ETTA
Entity Type:Individual
Prefix:
First Name:EBAI
Middle Name:HELENE ETTA
Last Name:KAMSU NASAH
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 1:21 DENTON PLZ
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-9501
Mailing Address - Country:US
Mailing Address - Phone:410-479-1771
Mailing Address - Fax:
Practice Address - Street 1:21 DENTON PLZ
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-9501
Practice Address - Country:US
Practice Address - Phone:302-226-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73960183500000X
MD28355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist