Healthcare Provider Details

I. General information

NPI: 1689620742
Provider Name (Legal Business Name): JOHN L. CANADY II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 COLLEGE AVE
MANHATTAN KS
66502-3381
US

IV. Provider business mailing address

3708 PERSIMMON CIR
MANHATTAN KS
66503-9684
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-1261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55353
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: