Provider Demographics
NPI:1265770770
Name:HASELDEN, SHARON M (RN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:HASELDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:652 S. MIDWAY HWY
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-0861
Mailing Address - Country:US
Mailing Address - Phone:843-386-2609
Mailing Address - Fax:843-386-3125
Practice Address - Street 1:237 S GEORGETOWN HWY
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555-8081
Practice Address - Country:US
Practice Address - Phone:843-386-2609
Practice Address - Fax:843-386-3125
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse