Healthcare Provider Details

I. General information

NPI: 1083723928
Provider Name (Legal Business Name): JENNIE K CANAN AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-8581
  • Fax:
Mailing address:
  • Phone: 202-782-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number719
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: