Provider Demographics
NPI:1558476929
Name:KANNE, GERALDINE E (NP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:E
Last Name:KANNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3320 WAKE FOREST RD
Mailing Address - Street 2:SUITE 120
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:919-431-9213
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:SUITE 120
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC900249363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner