Provider Demographics
NPI:1386111763
Name:KENAWELL, ERIN (CRNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:KENAWELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BRANDERMILL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1668
Mailing Address - Country:US
Mailing Address - Phone:410-721-1507
Mailing Address - Fax:410-721-1510
Practice Address - Street 1:2401 BRANDERMILL BLVD STE 250
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1668
Practice Address - Country:US
Practice Address - Phone:410-721-1507
Practice Address - Fax:410-721-1510
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD14461859Medicaid