| NPI | 1992109425 |
|---|---|
| Former Name | SUSAN CANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0000791) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0033550) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2016-11-08 |