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General NPI Number Information
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NPI Number | 1962168468
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Entity Type | Individual
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Provider Name | KENNY ADESHOLA AMANZE CRNP-PHM
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Gender | Female
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 915 RHODE ISLAND AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20001-4153
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Country | US
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Telephone | 240-643-5160
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Fax | 202-644-7024
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Provider Business Mailing Address
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Address Line | 2409 BAIKAL LOOP
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-7051
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Country | US
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Telephone | 240-643-5160
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R207092
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP1031662
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License Number State | DC
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