Provider Demographics
NPI:1205466109
Name:MAINA, PENINNAH
Entity type:Individual
Prefix:
First Name:PENINNAH
Middle Name:
Last Name:MAINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7542
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:1213 E TRINITY MILLS RD STE 173
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1446
Practice Address - Country:US
Practice Address - Phone:972-962-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199963363LF0000X
TX1114135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily