Healthcare Provider Details

I. General information

NPI: 1780799783
Provider Name (Legal Business Name): DEBORAH A. CANNEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date: 06/04/2008
Reactivation Date: 07/02/2008

III. Provider practice location address

152 FRONT ST
EXETER NH
03833-2329
US

IV. Provider business mailing address

152 FRONT ST
EXETER NH
03833-2329
US

V. Phone/Fax

Practice location:
  • Phone: 603-580-2949
  • Fax: 267-350-9184
Mailing address:
  • Phone: 603-580-2949
  • Fax: 267-350-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. GREGORY MARVIN PETERSEN
Title or Position: MANAGER
Credential: PEDORTHIST
Phone: 763-607-6874