Provider Demographics
NPI:1356545065
Name:CANIER, PATRICIA A
Entity type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:A
Last Name:CANIER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAT
Other - Middle Name:A
Other - Last Name:CANIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:223 N STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-1409
Mailing Address - Country:US
Mailing Address - Phone:815-238-4943
Mailing Address - Fax:
Practice Address - Street 1:701 W LAMM RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-9630
Practice Address - Country:US
Practice Address - Phone:815-233-6162
Practice Address - Fax:815-233-6167
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator