Provider Demographics
NPI:1861158917
Name:KANU, KWAME IMRAN
Entity type:Individual
Prefix:
First Name:KWAME IMRAN
Middle Name:
Last Name:KANU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 COATSBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2908
Mailing Address - Country:US
Mailing Address - Phone:202-867-6897
Mailing Address - Fax:
Practice Address - Street 1:8202 COATSBRIDGE CT
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2908
Practice Address - Country:US
Practice Address - Phone:202-867-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide