Provider Demographics
NPI:1558058040
Name:WOMBLE, ELONDA SADE' (AGNP-BC; NP-C)
Entity Type:Individual
Prefix:
First Name:ELONDA
Middle Name:SADE'
Last Name:WOMBLE
Suffix:
Gender:F
Credentials:AGNP-BC; NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 BENT PINE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9408
Mailing Address - Country:US
Mailing Address - Phone:919-498-5411
Mailing Address - Fax:
Practice Address - Street 1:1017 BENT PINE CIR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-9408
Practice Address - Country:US
Practice Address - Phone:919-498-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC272936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse