Individual
BRANDY L CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
315 SE STONEMILL DR STE 102, VANCOUVER, WA 98684-6987
(360) 816-2700
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60062925
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500651600
—
OR
01
—
P01306428
RR MEDICARE - PHS - OREGON
WA
Enumeration date
12/05/2008
Last updated
07/02/2021
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