Individual
DR. PETER PAUL CANNAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
230 E MARYDALE AVE, SUITE 1, SOLDOTNA, AK 99669-7648
(907) 260-3691
(907) 260-7301
Mailing address
PO BOX 2949, SOLDOTNA, AK 99669-2949
(907) 260-7300
(907) 260-7301
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
516
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FH177FQ
—
AK
05
—
MH0156
—
AK
Enumeration date
03/08/2007
Last updated
08/25/2016
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