Provider Demographics
NPI:1467489765
Name:CANALE, ANN M (NURSE PRACTIONIER)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:M
Last Name:CANALE
Suffix:
Gender:F
Credentials:NURSE PRACTIONIER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 JEFFERSON AVE
Mailing Address - Street 2:PFS-ADAMS BUILDING
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2807
Mailing Address - Country:US
Mailing Address - Phone:901-545-7651
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:901-545-8615
Practice Address - Fax:901-545-8198
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000111855363L00000X
TN7463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP37827Medicare UPIN
TN3908226Medicare ID - Type Unspecified