Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 1-077728 | AL |
NPI | 1083295810 |
---|---|
Provider Name | Stephanie Michelle Cannon |
First Address | Mount Olive, AL 35117-3606 |
Second Address | Birmingham, AL 35233-1802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |