Provider Demographics
NPI:1366494965
Name:HARRIS, SANDRA LAMBERT (PNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LAMBERT
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1390
Mailing Address - Fax:704-384-1063
Practice Address - Street 1:1900 RANDOLPH RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1122
Practice Address - Country:US
Practice Address - Phone:704-384-1390
Practice Address - Fax:704-384-1063
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300302363L00000X, 363LP0200X
NC166746363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005303Medicaid
NC1366494965Medicaid
SCNP1935Medicaid
SCNP1935Medicaid
NC7005303Medicaid
NC2592134Medicare PIN