Provider Demographics
NPI:1598052193
Name:HARSHAW, SANDRA VIVIAN (CNT/ PHLEBOTOMY)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:VIVIAN
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:CNT/ PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1712
Mailing Address - Country:US
Mailing Address - Phone:615-474-2050
Mailing Address - Fax:
Practice Address - Street 1:303 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1712
Practice Address - Country:US
Practice Address - Phone:615-474-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-02
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00120119376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00120119OtherBOARD OF NURSING/ CNT