Healthcare Provider Details

I. General information

NPI: 1437013893
Provider Name (Legal Business Name): ERIC AONSI KANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9621 MUIRKIRK RD # B195
LAUREL MD
20708-2619
US

IV. Provider business mailing address

9621 MUIRKIRK RD # B195
LAUREL MD
20708-2619
US

V. Phone/Fax

Practice location:
  • Phone: 227-215-8656
  • Fax:
Mailing address:
  • Phone: 227-215-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: