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Individual
CAROL A CANNON
Active
Individual
CAROL A CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
280058
MA
163WX0200X
Oncology Registered Nurse
SP019511
PA
363L00000X
Nurse Practitioner
Primary
SP019511
PA
363LA2100X
Acute Care Nurse Practitioner
280058
MA
Other
Enumeration date
08/11/2016
Last updated
02/11/2019
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