Individual
GRACE CANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 E BOULDER ST STE 2508, COLORADO SPRINGS, CO 80909
(719) 365-6999
(719) 365-2837
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(970) 624-4034
(970) 490-4347
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
008194
GA
367H00000X
Anesthesiologist Assistant
Primary
ANT.0000107
CO
Other
Enumeration date
12/01/2016
Last updated
02/27/2019
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