| NPI | 1053040816 |
|---|---|
| Former Name | GINA LEE CANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MI 4704341531) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704341531) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2024-11-25 |