Provider Demographics
NPI:1043593312
Name:CANNON, VICTORIA LEE (RN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:CANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 EAST TUSCARAWAS AVE.
Mailing Address - Street 2:PO BOX 735
Mailing Address - City:GNADENHUTTEN
Mailing Address - State:OH
Mailing Address - Zip Code:44629-0735
Mailing Address - Country:US
Mailing Address - Phone:330-827-7921
Mailing Address - Fax:
Practice Address - Street 1:449 EAST TUSCARAWAS AVE.
Practice Address - Street 2:
Practice Address - City:GNADENHUTTEN
Practice Address - State:OH
Practice Address - Zip Code:44629-0735
Practice Address - Country:US
Practice Address - Phone:330-827-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320986163WG0000X, 163WH0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical