Provider Demographics
NPI:1679750202
Name:CANNON, ROSEMARY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:ANN
Last Name:CANNON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:2379 GUS THOMASSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5302
Mailing Address - Country:US
Mailing Address - Phone:972-686-6400
Mailing Address - Fax:
Practice Address - Street 1:2379 GUS THOMASSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5302
Practice Address - Country:US
Practice Address - Phone:972-686-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX434735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner