Individual
CARLISSA CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6810 CLEMENT AVE, CLEVELAND, OH 44105-4939
(216) 856-4759
Mailing address
6810 CLEMENT AVE, CLEVELAND, OH 44105-4939
(216) 856-4759
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
501134280606
OH
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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