Provider Demographics
NPI:1124226527
Name:CANNON, ADRIA (BS, IBCLC)
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 TOKAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1227
Mailing Address - Country:US
Mailing Address - Phone:608-278-8879
Mailing Address - Fax:
Practice Address - Street 1:120 PAOLI ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1323
Practice Address - Country:US
Practice Address - Phone:608-845-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist