Provider Demographics
NPI:1316448582
Name:KENENISA, KUMSA L
Entity type:Individual
Prefix:
First Name:KUMSA
Middle Name:L
Last Name:KENENISA
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 1:13423 DEER HIGHLANDS WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6714
Mailing Address - Country:US
Mailing Address - Phone:202-427-5139
Mailing Address - Fax:
Practice Address - Street 1:13423 DEER HIGHLANDS WAY
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-6714
Practice Address - Country:US
Practice Address - Phone:202-427-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1035160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse