Provider Demographics
NPI:1730963059
Name:CANNON, LORRAINE MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARIE
Last Name:CANNON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 BROOKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-4004
Mailing Address - Country:US
Mailing Address - Phone:267-253-0168
Mailing Address - Fax:
Practice Address - Street 1:3549 BROOKVIEW RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-4004
Practice Address - Country:US
Practice Address - Phone:267-253-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027672363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care