Provider Demographics
NPI:1710104708
Name:CANADY, CONNIE LEE (CNM)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LEE
Last Name:CANADY
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2677
Practice Address - Country:US
Practice Address - Phone:910-608-3078
Practice Address - Fax:910-608-3079
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC188176B00000X
NC109106367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife