Healthcare Provider Details

I. General information

NPI: 1932652781
Provider Name (Legal Business Name): SHARON LEE CANNON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W LINN ST
NORMAN OK
73069-5837
US

IV. Provider business mailing address

1115 BILOXI DR APT. A
NORMAN OK
73071-2357
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-0022
  • Fax: 405-360-4918
Mailing address:
  • Phone: 405-514-4074
  • Fax: 405-364-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: