Provider Demographics
NPI:1922826049
Name:KANU, MEDLINA E
Entity type:Individual
Prefix:
First Name:MEDLINA
Middle Name:E
Last Name:KANU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 STERRETT PL STE 208
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2649
Mailing Address - Country:US
Mailing Address - Phone:301-615-1007
Mailing Address - Fax:
Practice Address - Street 1:5570 STERRETT PL STE 208
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2649
Practice Address - Country:US
Practice Address - Phone:301-615-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist