Healthcare Provider Details

I. General information

NPI: 1235634221
Provider Name (Legal Business Name): LAURA D CANNON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W FRANCISCAN DR
CROWN POINT IN
46307-4802
US

IV. Provider business mailing address

203 W FRANCISCAN DR
CROWN POINT IN
46307-4802
US

V. Phone/Fax

Practice location:
  • Phone: 630-320-6871
  • Fax:
Mailing address:
  • Phone: 630-320-6871
  • Fax: 630-385-0026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71007892A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: