Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | 32293 | SC |
N | 224P00000X | Prosthetist | C0120769 | GA |
Y | 224P00000X | Prosthetist | C92801 | NC |
NPI | 1255724423 |
---|---|
Provider Name | Dana Cannon |
First Address | Charlotte, NC 28209-1801 |
Second Address | Charlotte, NC 28209-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2015 |
Last Update Date | 12/03/2015 |