Healthcare Provider Details

I. General information

NPI: 1831295203
Provider Name (Legal Business Name): MARIANNE T. CANNON APRN PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 345F
BEVERLY MA
01915-6501
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE345F
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-535-6043
  • Fax:
Mailing address:
  • Phone: 978-535-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number101598
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: