Provider Demographics
NPI:1194144501
Name:CANNON, YOLANDA (LPN)
Entity type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 FOBES AVE
Mailing Address - Street 2:APT 512
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2141
Mailing Address - Country:US
Mailing Address - Phone:315-863-8939
Mailing Address - Fax:
Practice Address - Street 1:381 FOBES AVE
Practice Address - Street 2:APT 512
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2141
Practice Address - Country:US
Practice Address - Phone:315-863-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271274164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse