Provider Demographics
NPI:1427350917
Name:HASSELL, ERNESTINE ROUGHTON (RN)
Entity type:Individual
Prefix:MRS
First Name:ERNESTINE
Middle Name:ROUGHTON
Last Name:HASSELL
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 1:408 BRIDGE STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NC
Mailing Address - Zip Code:27925
Mailing Address - Country:US
Mailing Address - Phone:252-793-1751
Mailing Address - Fax:252-766-3376
Practice Address - Street 1:408 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NC
Practice Address - Zip Code:27925-0238
Practice Address - Country:US
Practice Address - Phone:252-793-1751
Practice Address - Fax:252-766-3376
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse