Provider Demographics
NPI:1063118115
Name:CANTERBURY, SHANNON LOGEL
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LOGEL
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 STONEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-9417
Mailing Address - Country:US
Mailing Address - Phone:828-260-5937
Mailing Address - Fax:
Practice Address - Street 1:150 STONEYBROOK LN
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-9417
Practice Address - Country:US
Practice Address - Phone:828-260-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC343253163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse