Individual
JENNIFER CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
BLDG 50, FARENHOLT AVENUE, AGANA HEIGHTS, GU 96910
(671) 344-9340
Mailing address
PSC 455 BOX 208, FPO, AP 96540-0003
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1942863154
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2019
Last updated
06/05/2024
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