Provider Demographics
NPI:1417983420
Name:JOSEPH, SALLY A (NP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 WEAVER DAIRY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1870
Mailing Address - Country:US
Mailing Address - Phone:984-974-7005
Mailing Address - Fax:984-974-9482
Practice Address - Street 1:1181 WEAVER DAIRY RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1869
Practice Address - Country:US
Practice Address - Phone:984-974-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC940069163WW0101X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592276Medicare ID - Type Unspecified
Q33253Medicare UPIN