| NPI | 1871266130 |
|---|---|
| Former Name | CAITLYN CANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP024080) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024080) |
| Enumeration Date | 2021-07-31 |
| Last Update Date | 2021-11-08 |