Healthcare Provider Details

I. General information

NPI: 1720901804
Provider Name (Legal Business Name): HAILEY JEAN CANNON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

5519 SWEDE AVE
MIDLAND MI
48642-7139
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-1817
  • Fax:
Mailing address:
  • Phone: 989-948-1420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704401732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: