Individual
BREANNE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 NE MOTHER JOSEPH PL STE 300, VANCOUVER, WA 98664
(360) 254-6161
(360) 449-1146
Mailing address
200 NE MOTHER JOSEPH PL STE 210, VANCOUVER, WA 98664-3295
(360) 254-6161
(360) 449-1146
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 60234603
WA
363AS0400X
Surgical Physician Assistant
PA 60234603
WA
Other
Enumeration date
04/22/2009
Last updated
04/13/2021
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