Provider Demographics
NPI:1053156695
Name:CANNON, DEBORAH MARIE (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:CANNON
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 W AXTON RD TRLR 4
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9641
Mailing Address - Country:US
Mailing Address - Phone:425-239-7144
Mailing Address - Fax:
Practice Address - Street 1:838 W AXTON RD TRLR 4
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9641
Practice Address - Country:US
Practice Address - Phone:425-239-7144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10008711376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide