Provider Demographics
NPI:1962932889
Name:KANNIER, SOFIA B
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:B
Last Name:KANNIER
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 1:1312 WALLACE RD NW APT 17
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3079
Mailing Address - Country:US
Mailing Address - Phone:971-770-8664
Mailing Address - Fax:
Practice Address - Street 1:799 LONG ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-3304
Practice Address - Country:US
Practice Address - Phone:541-367-3888
Practice Address - Fax:541-367-2407
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider