Provider Demographics
NPI:1477104925
Name:HARDEN, SHIRLEY NICOLE (DNP)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:NICOLE
Last Name:HARDEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TRAVIS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7912
Mailing Address - Country:US
Mailing Address - Phone:252-619-9755
Mailing Address - Fax:
Practice Address - Street 1:100 PLANK BRIDGE RD
Practice Address - Street 2:UNIT B
Practice Address - City:CAMDEN
Practice Address - State:NC
Practice Address - Zip Code:27921
Practice Address - Country:US
Practice Address - Phone:252-331-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC5015115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5015115OtherNC LICENSURE