Provider Demographics
NPI:1952053399
Name:VANNATTER, CANVAS ANN
Entity Type:Individual
Prefix:
First Name:CANVAS
Middle Name:ANN
Last Name:VANNATTER
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 1:65 BIG DEADENING
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524-7135
Mailing Address - Country:US
Mailing Address - Phone:304-855-4563
Mailing Address - Fax:
Practice Address - Street 1:65 BIG DEADENING
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-7135
Practice Address - Country:US
Practice Address - Phone:304-855-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant