DWAYNE OMAR ENNIS

LA PLATA, MD
NPI1700607835
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: MD  R173805)
Enumeration Date2024-10-21
Last Update Date2025-10-12
Business Address
DWAYNE OMAR ENNIS PMHNP-BC
1014 WASHINGTON AVE
LA PLATA, MD 20646-4228
Phone number: 917-560-5145
Mailing Address
DWAYNE OMAR ENNIS PMHNP-BC
1014 WASHINGTON AVE
LA PLATA, MD 20646-4228
Phone number: