Provider Demographics
NPI:1639450141
Name:CANNING, LAURICE M (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:M
Last Name:CANNING
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CANDLESTICK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-3235
Mailing Address - Country:US
Mailing Address - Phone:978-688-9842
Mailing Address - Fax:
Practice Address - Street 1:31 CANDLESTICK ROAD
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-3235
Practice Address - Country:US
Practice Address - Phone:978-688-9842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN 214836363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care