Provider Demographics
NPI:1972143238
Name:CANNON, TAMIERE (CNA)
Entity Type:Individual
Prefix:
First Name:TAMIERE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 MARTHA ST APT I
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-6729
Mailing Address - Country:US
Mailing Address - Phone:720-309-7312
Mailing Address - Fax:
Practice Address - Street 1:3100 MARTHA ST APT I
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-6729
Practice Address - Country:US
Practice Address - Phone:720-309-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty