Provider Demographics
NPI:1578549408
Name:CANNON, DENISE A (NP-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:CANNON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:A
Other - Last Name:DOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:10101 N 92ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4553
Mailing Address - Country:US
Mailing Address - Phone:480-860-1919
Mailing Address - Fax:480-860-5620
Practice Address - Street 1:10101 N 92ND ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4553
Practice Address - Country:US
Practice Address - Phone:480-860-1919
Practice Address - Fax:480-860-1580
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2184363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52217Medicare UPIN
104722Medicare ID - Type Unspecified