Provider Demographics
NPI:1952785446
Name:KANU, NNEKA U
Entity Type:Individual
Prefix:MRS
First Name:NNEKA
Middle Name:U
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 1:1977 CLINTON AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5028
Mailing Address - Country:US
Mailing Address - Phone:917-982-5978
Mailing Address - Fax:
Practice Address - Street 1:1977 CLINTON AVE
Practice Address - Street 2:APT 2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5028
Practice Address - Country:US
Practice Address - Phone:917-982-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317592164W00000X
NJ26NP07050600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY317592OtherTHE UNIVERSITY OF THE STATE OF NEWYORK EDUCATION DEPARTMENT
NJ26NP07050600OtherNEWJERSEY OFFICE OF THE ATTORNEY GENERAL DIVISION OF CONSUMER AFFAIRS