Individual
DWAYNE OMAR ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
1014 WASHINGTON AVE, LA PLATA, MD 20646-4228
(917) 560-5145
Mailing address
1014 WASHINGTON AVE, LA PLATA, MD 20646-4228
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R173805
MD
Other
Enumeration date
10/21/2024
Last updated
02/06/2026
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