Provider Demographics
NPI:1427707561
Name:CANNON, LANEICE R
Entity type:Individual
Prefix:MRS
First Name:LANEICE
Middle Name:R
Last Name:CANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 VIA VERONA
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2852
Mailing Address - Country:US
Mailing Address - Phone:661-575-4986
Mailing Address - Fax:
Practice Address - Street 1:2618 VIA VERONA
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2852
Practice Address - Country:US
Practice Address - Phone:661-575-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care