Provider Demographics
NPI:1669657599
Name:CANNON, MARKQUISA (LPN)
Entity Type:Individual
Prefix:
First Name:MARKQUISA
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2445
Mailing Address - Country:US
Mailing Address - Phone:440-439-1494
Mailing Address - Fax:
Practice Address - Street 1:5647 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2445
Practice Address - Country:US
Practice Address - Phone:440-439-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse