Provider Demographics
NPI:1326414012
Name:KANNEH, MARIAMA (LVN)
Entity type:Individual
Prefix:MRS
First Name:MARIAMA
Middle Name:
Last Name:KANNEH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11924 GARDEN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5042
Mailing Address - Country:US
Mailing Address - Phone:972-904-4742
Mailing Address - Fax:
Practice Address - Street 1:11924 GARDEN TERRACE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5042
Practice Address - Country:US
Practice Address - Phone:972-904-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300498164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse