Provider Demographics
NPI:1720792484
Name:ANDERSON-CANNON, YASMEEN ALEXANDERIA (LVN)
Entity Type:Individual
Prefix:
First Name:YASMEEN
Middle Name:ALEXANDERIA
Last Name:ANDERSON-CANNON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 4TH ST APT 807
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1251
Mailing Address - Country:US
Mailing Address - Phone:323-328-6648
Mailing Address - Fax:
Practice Address - Street 1:125 W 4TH ST APT 807
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1251
Practice Address - Country:US
Practice Address - Phone:323-328-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA718662164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty