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General NPI Number Information
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NPI Number | 1811570815
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Entity Type | Individual
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Provider Name | ANTONETTE SALLAY KANU FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 509 S CHERRY GROVE AVE STE C
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4235
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Country | US
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Telephone | 844-322-4222
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Fax | 443-400-0509
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Provider Business Mailing Address
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Address Line | 509 S CHERRY GROVE AVE STE C
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4235
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Country | US
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Telephone | 844-322-4222
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Fax | 443-400-0509
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R208761
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License Number State | MD
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