Provider Demographics
NPI:1063254696
Name:CANNON, PARRIS-MARIE (CNM, NP)
Entity type:Individual
Prefix:
First Name:PARRIS-MARIE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ASSUMPTION ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-1502
Mailing Address - Country:US
Mailing Address - Phone:203-809-1757
Mailing Address - Fax:
Practice Address - Street 1:47 ASSUMPTION ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-1502
Practice Address - Country:US
Practice Address - Phone:203-809-1757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT558367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife