Provider Demographics
NPI:1386299055
Name:CAMPBELL, SHARON HENDRICKSON (RN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:HENDRICKSON
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:HENDRICKSON
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6105 MILL GROVE RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7555
Mailing Address - Country:US
Mailing Address - Phone:704-882-4374
Mailing Address - Fax:
Practice Address - Street 1:6105 MILL GROVE RD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7555
Practice Address - Country:US
Practice Address - Phone:704-882-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse