Active NPI
Gregory Cannistraci, PA-C
- Physician Assistant
- Camano Island, WA
National Provider Identifier
1861795452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA3696
- Practice address
- 771 Fox Trot Way
Camano Island, WA 98282-8861 - Phone
- (360) 629-6205
- NPI assigned
- Dec 21, 2010
- Last updated
- Dec 21, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA3696 | WA | Primary |
Addresses
Primary practice location
771 Fox Trot Way
Camano Island, WA 98282-8861
Mailing address
771 Fox Trot Way
Camano Island, WA 98282-8861
Phone (360) 629-6205
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 |
|---|---|---|---|
| PA3696 | WA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292889600000",
"number": "1861795452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "771 FOX TROT WAY",
"city": "CAMANO ISLAND",
"state": "WA",
"postal_code": "982828861",
"telephone_number": "360-629-6205"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "771 FOX TROT WAY",
"city": "CAMANO ISLAND",
"state": "WA",
"postal_code": "982828861",
"telephone_number": "360-629-6205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNISTRACI",
"first_name": "GREGORY",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-12-21",
"last_updated": "2010-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA3696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camano Island, WA
- Tristen Burden
- Veronica Callaghan, RN
- Camano Counseling Consulting and Wellness (Camano Counseling & Wellness)
- Camano Island Health System
- Camano Plastic and Skin Surgery PLLC (Camano Skin)
- Stephanie Lynn Carlson, LMP
- Cheri Carmean, N.D.
- John Jason Carreon, LMHCA
- Daniel Joseph Cevetello, DO
- Bruce Chessen, PH.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.