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General NPI Number Information
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NPI Number | 1043593312
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Entity Type | Individual
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Provider Name | VICTORIA LEE CANNON RN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 449 EAST TUSCARAWAS AVE.
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City | GNADENHUTTEN
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State | OH
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Zip | 44629-0735
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Country | US
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Telephone | 330-827-7921
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Fax |
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Provider Business Mailing Address
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Address Line | 449 EAST TUSCARAWAS AVE. PO BOX 735
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City | GNADENHUTTEN
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State | OH
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Zip | 44629-0735
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Country | US
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Telephone | 330-827-7921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 320986
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 320986
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 320986
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License Number State | OH
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