Healthcare Provider Details

I. General information

NPI: 1689117251
Provider Name (Legal Business Name): ERIN CANNON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 12/06/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E CHEVY CHASE DR STE. 110
GLENDALE CA
91206-4172
US

IV. Provider business mailing address

25039 WHEELER RD
NEWHALL CA
91321-3421
US

V. Phone/Fax

Practice location:
  • Phone: 801-380-2111
  • Fax:
Mailing address:
  • Phone: 801-380-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number823989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: