Provider Demographics
NPI:1881825248
Name:CANNON, CHRISTINE SMITH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:SMITH
Last Name:CANNON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1340 S DIVISION ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7095
Mailing Address - Country:US
Mailing Address - Phone:410-546-4427
Mailing Address - Fax:410-546-2096
Practice Address - Street 1:1340 S DIVISION ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7095
Practice Address - Country:US
Practice Address - Phone:410-546-4427
Practice Address - Fax:410-546-2096
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily