Individual
MELANIE SUSAN CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 452-6682
Mailing address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 452-6682
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209008933
IL
363LF0000X
Family Nurse Practitioner
ARNP9283382
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1713806
—
AK
01
—
59-2420282
TAX ID
FL
Enumeration date
01/06/2011
Last updated
12/06/2024
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