Provider Demographics
NPI:1386462737
Name:KANANA, DEO
Entity type:Individual
Prefix:
First Name:DEO
Middle Name:
Last Name:KANANA
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 1:252 KENNEDY DR APT 312
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3321
Mailing Address - Country:US
Mailing Address - Phone:857-266-1934
Mailing Address - Fax:
Practice Address - Street 1:1 BATHOL ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3655
Practice Address - Country:US
Practice Address - Phone:781-245-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN102382164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse