Provider Demographics
NPI:1215221775
Name:HARRELL, SALLIE N (NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SALLIE
Middle Name:N
Last Name:HARRELL
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 LEGACY FARE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-9721
Mailing Address - Country:US
Mailing Address - Phone:336-617-8009
Mailing Address - Fax:
Practice Address - Street 1:1196 LEGACY FARE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313-9721
Practice Address - Country:US
Practice Address - Phone:336-617-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC183277163W00000X
NC0050-01544363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse