Individual
BERNADETTE GALICIA CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3998 FAIR RIDGE DR., SUITE 320, FAIRFAX, VA 22033-2921
(703) 295-9360
(703) 295-9369
Mailing address
PO BOX 37090, BALTIMORE, MD 21297-3090
(703) 295-9360
(703) 295-9369
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001159170
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024167778
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528244514
—
VA
Enumeration date
01/21/2008
Last updated
03/03/2021
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