MEDICARE: NADINE G KAKANOU CRNP-PMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R206958	MD

General Provider Information

NPI Number	:	1063044279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADINE G KAKANOU CRNP-PMH

Provider Business Mailing Address
First Line	:	14760 MCKNEW RD
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1358
Country	:	US
Telephone Number	:	301-536-0615
Fax Number	:

Provider Business Practice Location Address
First Line	:	14760 MCKNEW RD
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1358
Country	:	US
Telephone Number	:	301-536-0615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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