Healthcare Provider Details

I. General information

NPI: 1437896388
Provider Name (Legal Business Name): CHRISTINE CONNOLLY CANNON CNM-BC, WHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W AVENUE J
LANCASTER CA
93534-2814
US

IV. Provider business mailing address

1940 OBERLIN AVE
THOUSAND OAKS CA
91360-2048
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5000
  • Fax:
Mailing address:
  • Phone: 805-558-1481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number236268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: