MEDICARE: ISATU TATA KANU

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	163W00000X	Registered Nurse	RN1041869	DC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RNP1041869	DC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R225358	MD

General Provider Information

NPI Number	:	1891058913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISATU TATA KANU

Provider Business Mailing Address
First Line	:	9609 DAPPER TOWN ROW
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5882
Country	:	US
Telephone Number	:	202-281-5205
Fax Number	:	202-281-5205

Provider Business Practice Location Address
First Line	:	9609 DAPPER TOWN ROW
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5882
Country	:	US
Telephone Number	:	202-281-5205
Fax Number	:	202-281-5205

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

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	03/16/2026

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Directions to “ ISATU TATA KANU ” Practice Location

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