Individual
TERESA SUDDRETH THARPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GONP
Contact information
Practice address
150 PARKWOOD DR, ELKIN, NC 28621-2430
(336) 835-5945
Mailing address
150 PARKWOOD DR, ELKIN, NC 28621-2430
(336) 835-5945
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
800061
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609198209
—
NC
01
—
NCS801A
MEDICARE PTAN
NC
Enumeration date
02/23/2010
Last updated
12/13/2016
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