Individual
BIANCA CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
27 MAIN AVE, WHEATLEY HEIGHTS, NY 11798-1407
(631) 433-4792
Mailing address
27 MAIN AVE, WHEATLEY HEIGHTS, NY 11798-1407
(631) 433-4792
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
650541
NY
Other
Enumeration date
08/30/2012
Last updated
08/30/2012
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