Provider Demographics
NPI:1083233852
Name:CANAVAN, ANNA K (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:K
Last Name:CANAVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:20 WALNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2104
Mailing Address - Country:US
Mailing Address - Phone:617-466-3373
Mailing Address - Fax:857-259-4807
Practice Address - Street 1:20 WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2104
Practice Address - Country:US
Practice Address - Phone:617-466-3373
Practice Address - Fax:857-259-4807
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2021-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA7998363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant