Provider Demographics
NPI:1982387783
Name:CANNON, ELIZABETH SUZANNE (APRN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:CANNON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18676 E CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5047
Mailing Address - Country:US
Mailing Address - Phone:405-863-4351
Mailing Address - Fax:
Practice Address - Street 1:425 E 22ND ST STE 102B
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4486
Practice Address - Country:US
Practice Address - Phone:918-376-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK214515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily