| Doctor Name: | SHANA C PROFFITT |
| NPI Number: | 1407109309 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | 202133 |
| Business Practice Address: | 845 Malcolm Blvd Rutherford College, NC - 286710476 |
| Business Phone Number: | 8288740555 |
| Business Fax Number: | 8288742111 |
| Mailing Address: | 845 Malcolm Blvd, RUTHERFORD COLLEGE |
| State: | NC |
| Postal Code: | 286710476 |
| Phone Number: | 8288740555 |
| Fax Number: | 8288742111 |
| NPI Enumeration Date: | 10/17/2012 |
| NPI Last Update Date: | 10/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 202133 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |