Individual
AMANDA GORDON CANCILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
Mailing address
225 BALDWIN AVE, CHARLOTTE, NC 28204-3109
(704) 376-1605
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
005001127
NC
Other
Enumeration date
03/20/2006
Last updated
09/17/2020
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