MEDICARE: NANA A MENSAH FNP, AANP

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	363L00000X	Nurse Practitioner	F04190068	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F04190068	OTHER		F04190068

General Provider Information

NPI Number	:	1902369168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANA A MENSAH FNP, AANP

Provider Business Mailing Address
First Line	:	3300 OLNEY SANDY SPRING RD STE 140
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1494
Country	:	US
Telephone Number	:	301-570-6245
Fax Number	:	240-389-1888

Provider Business Practice Location Address
First Line	:	3300 OLNEY SANDY SPRING RD STE 140
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1494
Country	:	US
Telephone Number	:	301-570-6245
Fax Number	:	240-389-1888

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	03/16/2021

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