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General NPI Number Information
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NPI Number | 1811958028
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Entity Type | Individual
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Provider Name | LUCY R CANADAY MD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 107 E HIGHLAND DR
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City | OCONTO FALLS
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State | WI
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Zip | 54154-1002
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Country | US
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Telephone | 920-846-3092
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Fax | 920-846-8313
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Provider Business Mailing Address
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Address Line | PO BOX 22487
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City | GREEN BAY
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State | WI
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Zip | 54305-2487
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Country | US
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Telephone | 920-445-7226
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Fax | 920-445-7289
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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 | 47569-20
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License Number State | WI
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