Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 12734 | NC |
NPI | 1053927970 |
---|---|
Provider Name | Shannon Cain |
First Address | Chinquapin, NC 28521-8782 |
Second Address | Chinquapin, NC 28521-8782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2020 |
Last Update Date | 16/09/2020 |