Healthcare Provider Details

I. General information

NPI: 1962099564
Provider Name (Legal Business Name): SHANNON PAIGE WHITSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WILMORE DR
CHARLOTTE NC
28203-4340
US

IV. Provider business mailing address

1601 WILMORE DR
CHARLOTTE NC
28203-4340
US

V. Phone/Fax

Practice location:
  • Phone: 704-222-4741
  • Fax:
Mailing address:
  • Phone: 704-222-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number240767
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: