Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 2013-01284 | NC |
NPI | 1043292386 |
---|---|
Provider Name | Shannon Wright Longshore |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-2849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 17/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043292386 | (05) | NC |
180Y3 | BCBSNC (01) | NC |
RES000 | (02) | CA |