Individual
JANICE ELIZABETH SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LN
Contact information
Practice address
4375 TIDEMARSH CT, SOUTHPORT, NC 28461-8314
(910) 854-0570
Mailing address
4375 TIDEMARSH CT, SOUTHPORT, NC 28461-8314
(910) 854-0570
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
NU000008
NC
133NN1002X
Nutrition Education Nutritionist
NU000008
NC
Other
Enumeration date
04/14/2021
Last updated
04/14/2021
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