Individual
LISA CLAIRE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC A
Contact information
Practice address
1600 SUTTER PL, CLOVIS, NM 88101-4611
(505) 769-4490
(505) 935-0011
Mailing address
1427 COLONIAL PKWY, CLOVIS, NM 88101-3107
(505) 742-1976
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2459
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000Z7838
—
NM
Enumeration date
11/06/2006
Last updated
07/08/2007
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