Provider Demographics
NPI:1639725245
Name:CANNADY, ANGELA DE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DE
Last Name:CANNADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SCENIC PL
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-9731
Mailing Address - Country:US
Mailing Address - Phone:360-249-0112
Mailing Address - Fax:
Practice Address - Street 1:5 SCENIC PL
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-9731
Practice Address - Country:US
Practice Address - Phone:360-249-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60991339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily