Provider Demographics
NPI:1629211727
Name:SHIRES, MARGARET BRALLEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:BRALLEY
Last Name:SHIRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:ELIZABETH
Other - Last Name:BRALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-6478
Mailing Address - Fax:704-384-8220
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-6478
Practice Address - Fax:704-384-8220
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC188989363LG0600X
NC5004379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology