Provider Demographics
NPI:1588797708
Name:TEAGUE, SHARON JOHNSON (RN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:JOHNSON
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHARYN
Other - Middle Name:J
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2300 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:910-488-2120
Mailing Address - Fax:910-822-7982
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-822-7982
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC054737163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse