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General NPI Number Information
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NPI Number | 1245632157
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Entity Type | Individual
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Provider Name | AMANDA CANNON
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 101 E 2ND ST
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City | KENLY
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State | NC
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Zip | 27542-7794
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Country | US
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Telephone | 919-284-4025
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Fax | 919-284-5965
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Provider Business Mailing Address
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Address Line | PO BOX 275
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City | KENLY
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State | NC
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Zip | 27542-0275
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Country | US
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Telephone | 919-284-4025
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Fax | 919-284-5965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 5007198
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License Number State | NC
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