MARY CANONICO (NPI# 1811465594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811465594 |
| Entity Type | Individual |
| Full Name | MARY CANONICO |
| Credential | PMHNP-BC |
| Practice Address |
202 E Bagley Rd Berea OH 44017-2058 |
| Practice Telephone | 2162966845 |
| Mailing Telephone | 4402342006 |
| Enumeration Date | 2018-11-11 |
| Last Update Date | 2019-01-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
023823 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
202 E BAGLEY RD |
| City | BEREA |
| State | OH |
| Zip Code | 44017-2058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063409787 | Michelle Monica Hartis | Social Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2005-09-29 |
| 1083214738 | Jessica Hucks | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-10-30 |
| 1265031421 | Larissa Giese | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-10-20 |
| 1538767744 | Kelly Howard | Registered Nurse | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-10-12 |
| 1760089577 | Meghan Leah Wharton | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-10-05 |
| 1215543509 | Kevin P James | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-09-22 |
| 1023624624 | Horace Joel Whitworth | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-09-18 |
| 1790391605 | Angliette Drake | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-09-17 |
| 1093321838 | Charlene Jackson | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-09-17 |
| 1326669086 | Dejah M Sprouse | Community Health Worker | 202 E Bagley Rd, Berea, OH 44017-2058 | 2020-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023632759 | Faseeha Raza | Student in an Organized Health Care Education/Training Program | Baldwin Wallace University Physician Assistant Program, 201 Front Street, Berea, OH 44017 | 2020-05-28 |
| 1851885412 | Monica Lynne Mcfarland | Occupational Therapy Assistant | 570 North Rocky River Drive, Berea, OH 44017 | 2018-06-18 |
| 1700301207 | Cherelle Scott | Counselor | 398 W Bagley Road Ste, Suite 216, Berea, OH 44017 | 2017-08-07 |
| 1780042457 | Linda Lou Cummings | Social Worker | 202 E. Bagley Road, Berea, OH 44017 | 2016-02-09 |
| 1760827042 | Pathways Hospice LLC | Hospice Care, Community Based | 885 W. Bagley Road, Berea, OH 44017 | 2013-05-01 |
| 1336457134 | Mary Elizabeth Italiano-burke | Licensed Practical Nurse | 90 Emerson Dr., #11009, Berea, OH 44017 | 2010-09-15 |
| 1720260979 | Cooperative Medical Health Care Corporation Professional Association | Mechanotherapist | 165 W. Bagley Rd., Berea, OH 44017 | 2007-11-29 |
| 1326230616 | Marilyn Sue George | Psychoanalyst | 187 Seminary St, Berea, OH 44017 | 2007-08-10 |
| 1437371556 | Michael Charles Powell | Registered Nurse | 501 Nobottom Rd, Berea, OH 44017 | 2007-05-02 |
| 1538381439 | Paula Davis Fultz | Counselor | 303 E. Bagley Road, Berea, OH 44017 | 2007-05-02 |
| Find all providers in zip 44017 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376600635 | Annie Ruth Bland | Nurse Practitioner | 132 Mini Mall Drive, Berea Health Ministry, Inc., Berea, KY 40403-1170 | 2007-01-03 |
| 1952963282 | Jennifer R. Hamblin | Nurse Practitioner | 292 Glades Rd Ste 8, Berea, KY 40403-1368 | 2019-07-08 |
| 1922196963 | Rachael Hovermale | Nurse Practitioner | 305 Estill St, Berea, KY 40403-1742 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770184707 | Joanna Sue Tricaso-torrence | Nurse Practitioner | 3567 Reserve Commons Dr Ste 100, Medina, OH 44256-5344 | 2020-11-05 |
| 1427658368 | Greta Katherine Heckmann | Nurse Practitioner | 2508 Beechmont Ave Apt 43, Cincinnati, OH 45230-1240 | 2020-10-29 |
| 1083213078 | Smtia Sonali Carpenter | Nurse Practitioner | 9509 Knarwood Ct, Pickerington, OH 43147-8106 | 2020-10-20 |
| 1255939054 | Jessica Kincaid | Nurse Practitioner | 3921 Clareridge Dr Unit B, Toledo, OH 43623-3380 | 2020-10-14 |
| 1801493531 | Kasey Zink | Nurse Practitioner | 5934 Creek Rd Se, Washington Court House, OH 43160-8778 | 2020-10-06 |
| 1861099806 | Taylor Buck | Nurse Practitioner | 158 Rock Creek Dr, Delaware, OH 43015-2260 | 2020-10-02 |
| 1598371296 | Peace of Mind Therapeutics LLC | Nurse Practitioner | 5170 Pebble Brook Dr, Englewood, OH 45322-3632 | 2020-09-17 |
| 1003421827 | Rachel Bird | Nurse Practitioner | 2900 Presidential Dr Ste 100, Beavercreek, OH 45324-6502 | 2020-09-09 |
| 1740894880 | Angel M Davis | Nurse Practitioner | 11210 Navajo Ln Apt 203, Parma Heights, OH 44130-9045 | 2020-09-05 |
| 1548873680 | Nicollette Pizzoferrato | Nurse Practitioner | 600 W Goodale St Apt 261, Columbus, OH 43215-1904 | 2020-08-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.