Active NPI
Hollie Cannelos
- Specialist
- Everett, WA
National Provider Identifier
1043769904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA00016819
- Practice address
- 2312 Rucker Ave
Everett, WA 98201-2723 - Phone
- (425) 923-5433
- Fax
- (425) 322-5004
- NPI assigned
- Oct 3, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA00016819 | WA | Primary |
Addresses
Primary practice location
2312 Rucker Ave
Everett, WA 98201-2723
Mailing address
2312 Rucker Ave
Everett, WA 98201-2723
Phone (425) 923-5433
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00016819 | WA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Knead to Heal, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Medical Specialty Clinic/Center
- Everett, WA
- NPI 1811377484
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475452800000",
"number": "1043769904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2312 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982012723",
"telephone_number": "425-923-5433",
"fax_number": "425-322-5004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2312 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982012723",
"telephone_number": "425-923-5433",
"fax_number": "425-322-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNELOS",
"first_name": "HOLLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-03",
"last_updated": "2016-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "MA00016819",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.