Individual
DANA CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COSMETOLOGIST
Contact information
Practice address
2805 SOUTH BLVD, CHARLOTTE, NC 28209-1801
(704) 527-0200
Mailing address
2805 SOUTH BLVD, CHARLOTTE, NC 28209-1801
(704) 527-0200
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
32293
SC
224P00000X
Prosthetist
C0120769
GA
224P00000X
Prosthetist
Primary
C92801
NC
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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