Healthcare Provider Details

I. General information

NPI: 1427562701
Provider Name (Legal Business Name): KENYATTE ZABRE CANIDATE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SOUTH FRONT STREET 5TH FLOOR BMA
HARRISBURG PA
17104-1619
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8360
  • Fax: 717-231-8358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP017411
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: