Individual ProviderBernadette Galicia CanonNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3998 Fair Ridge Dr., Suite 320, Fairfax, VA 22033-2921(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Bernadette Galicia Canon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1528244514Provider TypeIndividualFull NameCanon, Bernadette GaliciaCredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date1/21/2008Last Updated3/3/2021Contact InformationPractice LocationPractice Address3998 Fair Ridge Dr., Suite 320, Fairfax, VA 22033-2921Phone(703) 295-9360Fax(703) 295-9369Mailing LocationMailing AddressPO Box 37090, Baltimore, MD 21297-3090Phone(703) 295-9360Fax(703) 295-9369Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024167778VirginiaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense0001159170VirginiaProvider IdentifiersIDDescriptionIssuerID1528244514DescriptionMedicaidIssuerUnlistedVirginia