Individual
DEDRA SALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
10010 FALLS OF NEUSE RD, SUITE 205, RALEIGH, NC 27614-8494
(919) 350-1380
(919) 350-7918
Mailing address
10010 FALLS OF NEUSE RD, SUITE 205, RALEIGH, NC 27614-8494
(919) 350-1380
(919) 556-0124
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
25ME00056000
NJ
367A00000X
Advanced Practice Midwife
25ME00056001
NJ
367A00000X
Advanced Practice Midwife
Primary
583
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821492315
—
NC
Enumeration date
10/13/2014
Last updated
06/21/2019
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