Individual
DR. JOHN J CANNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
729 N CUSTER AVE, GRAND ISLAND, NE 68803-4311
(308) 382-9266
(308) 382-5290
Mailing address
729 N CUSTER AVE, P.O. BOX 2339, GRAND ISLAND, NE 68803-4311
(308) 382-9266
(308) 382-5290
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12464
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01707
BCBS INDIVIDUAL #
NE
05
—
47059252300
—
NE
Enumeration date
07/13/2005
Last updated
07/13/2007
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