Provider Demographics
NPI:1285608331
Name:CANTY, NANCY V (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:V
Last Name:CANTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9339 GENESEE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2119
Mailing Address - Country:US
Mailing Address - Phone:858-455-7520
Mailing Address - Fax:858-554-1312
Practice Address - Street 1:9339 GENESEE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2119
Practice Address - Country:US
Practice Address - Phone:858-455-7520
Practice Address - Fax:858-554-1312
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN538827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95460Medicaid
CANP95460Medicaid
CAP01498Medicare UPIN