Provider Demographics
NPI:1538610373
Name:HUGHES, KANITA (NURSE)
Entity type:Individual
Prefix:
First Name:KANITA
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13809 DR EDELEN DR
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607
Mailing Address - Country:US
Mailing Address - Phone:202-320-0090
Mailing Address - Fax:800-866-3108
Practice Address - Street 1:13809 DR EDELEN DR
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607
Practice Address - Country:US
Practice Address - Phone:202-320-0090
Practice Address - Fax:800-866-3108
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL1170-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility