Adria Cannon, B.S., I.B.C.L.C
Individual provider Active NPI Specialist · Verona, WI
NPI 1124226527 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124226527
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- Practice address
- 120 Paoli St
Verona, WI 53593-1323 - Phone
- (608) 845-7269
- NPI assigned
- Jul 6, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Yes |
Addresses
Primary practice location
120 Paoli St
Verona, WI 53593-1323
Mailing address
4914 Tokay Blvd
Madison, WI 53711-1227
Phone (608) 278-8879
Other providers in Verona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.