Individual
KATRINA TERESE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MS, CMD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35725
IA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
35725
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0732552
—
IA
01
—
26710
WELLMARK BCBS
IA
Enumeration date
08/30/2006
Last updated
08/01/2011
Update your record
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