Individual
STEPHANIE CANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
100 E WOOD ST STE 202, SPARTANBURG, SC 29303-3058
(864) 560-7070
(864) 560-7073
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21115
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4876
—
SC
01
—
SCB4707628
MEDICARE PIN
SC
Enumeration date
07/03/2017
Last updated
12/08/2020
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