Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | T2131 | TX |
NPI | 1104288398 |
---|---|
Provider Name | Nicole Canon |
First Address | Pearland, TX 77584-7298 |
Second Address | Denver, CO 80206-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2016 |
Last Update Date | 20/07/2021 |