Individual
JESSICA CANAAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
144 MERCHANTS CIR, HAMPSTEAD, NC 28443-5260
(910) 803-0340
Mailing address
1015 NUTT ST APT 244, WILMINGTON, NC 28401-4381
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09661
NC
Other
Enumeration date
05/11/2020
Last updated
05/11/2020
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