Cannon, Octavia Manetta

Cannon, Octavia Manetta is an individual health care provider with primary practice located at 1560 Turf Ln , East Lansing MI 48823-6392. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is her primary health care specialty. Cannon, Octavia Manetta can be contacted via phone (517) 484-3000.

Contact Information

Primary practice address
1560 Turf Ln East Lansing MI 48823-6392
Phone: (517) 484-3000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 9900020 North Carolina
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 99-00020 North Carolina
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 5101012864 Michigan

Profile Details

NPI number 1497734701
LBN Legal business name Cannon, Octavia Manetta
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2006
Last updated Sep 2nd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497734701 NPPES
Michigan Other 5101012864 MICHIGAN PHYSICIAN LICENSE
Michigan MEDICAID 891197H MICHIGAN PHYSICIAN LICENSE

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