Individual
GREGORY CANNISTRACI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
771 FOX TROT WAY, CAMANO ISLAND, WA 98282-8861
(360) 629-6205
Mailing address
771 FOX TROT WAY, CAMANO ISLAND, WA 98282-8861
(360) 629-6205
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3696
WA
Other
Enumeration date
12/21/2010
Last updated
12/21/2010
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