Amanze, Kenny Adeshola

Amanze, Kenny Adeshola is an individual health care provider with primary practice located at 2409 Baikal Loop , Upper Marlboro MD 20774-7051. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Amanze, Kenny Adeshola can be contacted via phone (240) 643-5160.

Contact Information

Primary practice address
2409 Baikal Loop Upper Marlboro MD 20774-7051
Phone: (240) 643-5160
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X R207092 Maryland

Profile Details

NPI number 1962168468
LBN Legal business name Amanze, Kenny Adeshola
Credentials CRNP-PHM
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2021
Last updated Nov 10th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962168468 NPPES
Maryland MEDICAID 1043645344
Maryland MEDICAID 1083094056

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