Provider Demographics
NPI:1871885616
Name:CANNON, MEGAN (NP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KNELLS RIDGE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4885
Mailing Address - Country:US
Mailing Address - Phone:757-436-1234
Mailing Address - Fax:757-548-3665
Practice Address - Street 1:108 KNELLS RIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4885
Practice Address - Country:US
Practice Address - Phone:757-436-1234
Practice Address - Fax:757-548-3665
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily