Healthcare Provider Details

I. General information

NPI: 1427280114
Provider Name (Legal Business Name): SHANA B PUTNAM CRT, RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E MAIN ST STE 18
WILLIAMSTON NC
27892-2482
US

IV. Provider business mailing address

PO BOX 1041
WILLIAMSTON NC
27892-1041
US

V. Phone/Fax

Practice location:
  • Phone: 252-792-1659
  • Fax: 252-792-2043
Mailing address:
  • Phone: 252-792-1659
  • Fax: 252-792-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number5984
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: