Healthcare Provider Details

I. General information

NPI: 1265770770
Provider Name (Legal Business Name): SHARON M HASELDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 S GEORGETOWN HWY
JOHNSONVILLE SC
29555-8081
US

IV. Provider business mailing address

PO BOX 861 652 S. MIDWAY HWY
JOHNSONVILLE SC
29555-0861
US

V. Phone/Fax

Practice location:
  • Phone: 843-386-2609
  • Fax: 843-386-3125
Mailing address:
  • Phone: 843-386-2609
  • Fax: 843-386-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number39534
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: