Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 900057 | NC |
NPI | 1003990169 |
---|---|
Provider Name | Karol Suzette Harshaw-Ellis |
First Address | Durham, NC 27713-6690 |
Second Address | Durham, NC 27713-6690 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 18/07/2007 |