Provider Demographics
NPI:1053464966
Name:DRINKARD, SUE ELLEN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ELLEN
Last Name:DRINKARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-5646
Mailing Address - Country:US
Mailing Address - Phone:336-294-6275
Mailing Address - Fax:
Practice Address - Street 1:1002 S EUGENE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1308
Practice Address - Country:US
Practice Address - Phone:336-271-5999
Practice Address - Fax:335-271-5990
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS70957Medicare UPIN