Provider Demographics
NPI:1366587008
Name:CANNON, DONNA JEAN (RN, NP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:JEAN
Last Name:CANNON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42444 W BLUE SUEDE SHOES LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-2274
Mailing Address - Country:US
Mailing Address - Phone:602-432-9591
Mailing Address - Fax:520-568-2117
Practice Address - Street 1:42444 W BLUE SUEDE SHOES LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2274
Practice Address - Country:US
Practice Address - Phone:602-432-9591
Practice Address - Fax:520-568-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN032234363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health