Provider Demographics
NPI:1821078023
Name:BUSSE, SHARDA NIRMALA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARDA
Middle Name:NIRMALA
Last Name:BUSSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6275
Mailing Address - Country:US
Mailing Address - Phone:336-475-2348
Mailing Address - Fax:336-475-2100
Practice Address - Street 1:200 ARTHUR DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6275
Practice Address - Country:US
Practice Address - Phone:336-475-2348
Practice Address - Fax:336-475-2100
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001135363LP2300X
NC5001135363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131753OtherMEDICAL LICENSE NUMBER
NC1212660021OtherDME
NC7004791Medicaid
NCP00784396OtherRR MEDICARE
NCP00784396OtherRR MEDICARE
NCQ61519Medicare UPIN
NC131753OtherMEDICAL LICENSE NUMBER