Provider Demographics
NPI:1891133120
Name:CANION, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CANION
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 1:4072 COUNTY ROAD 235
Mailing Address - Street 2:
Mailing Address - City:HARWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78632-4123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4072 COUNTY ROAD 235
Practice Address - Street 2:
Practice Address - City:HARWOOD
Practice Address - State:TX
Practice Address - Zip Code:78632-4123
Practice Address - Country:US
Practice Address - Phone:936-443-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX785293163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse