Healthcare Provider Details

I. General information

NPI: 1518995190
Provider Name (Legal Business Name): CANCER CENTERS OF NORTH CAROLINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 WAKE FOREST RD
RALEIGH NC
27609-7300
US

IV. Provider business mailing address

3320 WAKE FOREST RD
RALEIGH NC
27609-7300
US

V. Phone/Fax

Practice location:
  • Phone: 919-431-9201
  • Fax: 919-431-9213
Mailing address:
  • Phone: 919-431-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number900249
License Number StateNC

VIII. Authorized Official

Name: MRS. GERALDINE ELIZABETH KANNE
Title or Position: ADULT NURSE PRACTITIONER
Credential: ANP-C
Phone: 919-431-9201