Provider Demographics
NPI:1518995190
Name:CANCER CENTERS OF NORTH CAROLINA
Entity Type:Organization
Organization Name:CANCER CENTERS OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KANNE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-C
Authorized Official - Phone:919-431-9201
Mailing Address - Street 1:3320 WAKE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7300
Mailing Address - Country:US
Mailing Address - Phone:919-431-9201
Mailing Address - Fax:
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-431-9201
Practice Address - Fax:919-431-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900249261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP22108Medicare UPIN
NC2599463Medicare ID - Type Unspecified