Provider Demographics
NPI:1265474316
Name:CANNING, PATRICIA (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:CANNING
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:SILETZ
Mailing Address - State:OR
Mailing Address - Zip Code:97380
Mailing Address - Country:US
Mailing Address - Phone:541-444-1030
Mailing Address - Fax:541-444-9695
Practice Address - Street 1:200 GWEE-SHUT ROAD
Practice Address - Street 2:
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380
Practice Address - Country:US
Practice Address - Phone:541-444-1030
Practice Address - Fax:541-444-9695
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099006950RN363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ40211Medicare UPIN
OR93-0937095OtherCURRY HEALTH DISTRICT TAX I.D.
ORQ40211Medicare UPIN
OR1891930939OtherBROOKINGS PSYCHIATRY NPI