Provider Demographics
NPI:1760573612
Name:HARTSELL, MARY ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:HARTSELL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1500 SUNDAY DR
Mailing Address - Street 2:STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5151
Mailing Address - Country:US
Mailing Address - Phone:919-322-2413
Mailing Address - Fax:919-322-2416
Practice Address - Street 1:1500 SUNDAY DR STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-5151
Practice Address - Country:US
Practice Address - Phone:919-322-2413
Practice Address - Fax:919-322-2416
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY201194363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000168Medicaid
P01888Medicare UPIN
NC7000168Medicaid