Colleen M Canavan in Jerseyville - Physician Assistant
Colleen M Canavan - NPI 1205090644
Colleen M Canavan is a Physician Assistant in Jerseyville, Illinois. Colleen M Canavan practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Colleen M Canavan is 1205090644. The last update date is 2016-09-21.
Colleen M Canavan's current location address is 390 Maple Summit Rd, Jerseyville, Illinois. You can contact this provider via phone number 6184982101 and fax number 6184988153. The mailing address for Colleen M Canavan is 390 Maple Summit Rd, Jerseyville, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Colleen M Canavan |
|---|---|
| Address | 390 Maple Summit Rd, Jerseyville, Illinois |
| Phone Number | 6184982101 |
| Fax Number | 6184988153 |
| Sole Proprietor | N |
| Credentials | PA |
NPI Number Detail
| NPI Number | 1205090644 |
|---|---|
| Provider Enumeration Date | 2008-07-15 |
| Last Updated Date | 2016-09-21 |
Provider Mailing Address Detail
| Address | 390 Maple Summit Rd |
|---|---|
| City | Jerseyville |
| State | Illinois (IL) |
| Post Code | 620522000 |
| Phone Number | 6184982101 |
| Fax Number | 6184988153 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | 85000651 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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What is the unique identifier code issued to Colleen M Canavan by the Centers for Medicare & Medicaid Services (CMS)?
The Colleen M Canavan has been assigned the NPI (National Provider Identifier) 1205090644. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Where is the Colleen M Canavan located?
The Colleen M Canavan is located at 390 Maple Summit Rd, Jerseyville, IL 620522000.
What is Colleen M Canavan's specialized field of practice, and what is the corresponding taxonomy classification code?
The Colleen M Canavan's area of specialization is Physician Assistant, and the corresponding taxonomy code that categorizes this field of practice is 363A00000X.
On what date was the 1205090644 assigned to Colleen M Canavan?
The Colleen M Canavan was issued its 1205090644 on 2008-07-15, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the information related to Colleen M Canavan most recently updated or refreshed?
The details pertaining to the Colleen M Canavan, including its address, specialty, and other relevant information, were last updated or refreshed on 2016-09-21.