Ennis, Dwayne Omar

Ennis, Dwayne Omar is an individual health care provider with primary practice located at 1014 Washington Ave , La Plata MD 20646-4228. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Ennis, Dwayne Omar can be contacted via phone (917) 560-5145.

Contact Information

Primary practice address
1014 Washington Ave La Plata MD 20646-4228
Phone: (917) 560-5145
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X R173805 Maryland

Profile Details

NPI number 1700607835
LBN Legal business name Ennis, Dwayne Omar
Credentials PMHNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 21st, 2024
Last updated Feb 6th, 2026 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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