Individual
MRS. KATIE MARRIA CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 W SAINT GEORGES AVE FL 2, LINDEN, NJ 07036-3900
(908) 486-1111
(908) 486-2723
Mailing address
210 W SAINT GEORGES AVE FL 2, LINDEN, NJ 07036-3900
(908) 486-1111
(908) 486-2723
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
25MP00279100
NJ
363AS0400X
Surgical Physician Assistant
25MP00279100
NJ
Other
Enumeration date
02/16/2007
Last updated
12/16/2020
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