Provider Demographics
NPI:1104671148
Name:CANNARA, CHRISTOPHER RAYMOND (AGPCNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RAYMOND
Last Name:CANNARA
Suffix:
Gender:M
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-0273
Mailing Address - Country:US
Mailing Address - Phone:973-477-1491
Mailing Address - Fax:
Practice Address - Street 1:20 CARMELLA CT
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1350
Practice Address - Country:US
Practice Address - Phone:973-477-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15056400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner