Basic Information
| Provider Information | |||||||||
| NPI: | 1477104925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDEN | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 TRAVIS DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279097912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526199755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 PLANK BRIDGE RD | ||||||||
| Address2: | UNIT B | ||||||||
| City: | CAMDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523311829 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 10/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LF0000X | 5015115 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 5015115 | 01 | NC | NC LICENSURE | OTHER |