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General NPI Number Information
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NPI Number | 1639254576
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Entity Type | Individual
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Provider Name | COURTNEY ANNE CANAVERA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 1601 5TH AVE
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City | SEATTLE
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State | WA
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Zip | 98101-3621
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Country | US
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Telephone | 206-623-7671
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Fax |
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Provider Business Mailing Address
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Address Line | 275 W ROY ST #410
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City | SEATTLE
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State | WA
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Zip | 98119-4520
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Country | US
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Telephone | 206-285-4857
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00043403
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License Number State | WA
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