Individual
TAMMY CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
202 CRAIG AVE, FAIRBANKS, AK 99701-3657
(907) 799-6900
Mailing address
202 CRAIG AVE, FAIRBANKS, AK 99701-3657
(907) 799-6900
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
7553125
AK
Other
Enumeration date
08/16/2021
Last updated
08/16/2021
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