Individual
SAMUEL HARRISON CANNON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
Mailing address
29624 NETWORK PL, CHICAGO, IL 60673-1296
(608) 756-6278
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041353866
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100042105
—
WI
Enumeration date
03/27/2013
Last updated
04/10/2025
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