Provider Demographics
NPI:1992855944
Name:CANN, MISTY MELISSA
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:MELISSA
Last Name:CANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MELISSA
Other - Last Name:CANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:749 W 650 N
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3811
Mailing Address - Country:US
Mailing Address - Phone:801-686-1309
Mailing Address - Fax:
Practice Address - Street 1:2250 ROBINS DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1140
Practice Address - Country:US
Practice Address - Phone:801-779-3001
Practice Address - Fax:801-774-6100
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other