Provider Demographics
NPI:1962879270
Name:SELF, SANDRA HUGHES (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:HUGHES
Last Name:SELF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 US HIGHWAY 220 N
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9207
Mailing Address - Country:US
Mailing Address - Phone:336-643-7738
Mailing Address - Fax:
Practice Address - Street 1:4601 US HIGHWAY 220 N
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9207
Practice Address - Country:US
Practice Address - Phone:336-643-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily