Healthcare Provider Details

I. General information

NPI: 1558214841
Provider Name (Legal Business Name): THERESA KANNEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 360
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

103 SUMMIT AVE
THURMONT MD
21788-1870
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8494
  • Fax: 202-851-5002
Mailing address:
  • Phone: 301-792-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500339476
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: