Healthcare Provider Details

I. General information

NPI: 1821078023
Provider Name (Legal Business Name): SHARDA NIRMALA BUSSE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

IV. Provider business mailing address

200 ARTHUR DR
THOMASVILLE NC
27360-6275
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-2348
  • Fax: 336-475-2100
Mailing address:
  • Phone: 336-475-2348
  • Fax: 336-475-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number005001135
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5001135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: