Doctor Name: | DILYARA CANNON |
NPI Number: | 1114325784 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP7479 |
Business Practice Address: | 5653 S Highway 95 Ste A Fort Mohave, AZ - 864266068 |
Business Phone Number: | 9287682558 |
Business Fax Number: | 9287682874 |
Mailing Address: | 5653 S Highway 95, Ste A FORT MOHAVE |
State: | AZ |
Postal Code: | 864266068 |
Phone Number: | 9287682558 |
Fax Number: | 9287682874 |
NPI Enumeration Date: | 12/15/2014 |
NPI Last Update Date: | 12/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP7479 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |