Healthcare Provider Details

I. General information

NPI: 1245313279
Provider Name (Legal Business Name): SHARON POWERS HARTZOG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 POPLAR GROVE CONNECTOR SUITE B
BOONE NC
28607-5915
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR SUITE 100
CONCORD NC
28025-1831
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-8759
  • Fax: 828-262-5687
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number188644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: