Doctor Name: | SUNNY BAKALLI SEVERANCE |
NPI Number: | 1073878252 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 5005686 |
Business Practice Address: | 700 N Main St Stanley, NC - 281641438 |
Business Phone Number: | 7042638945 |
Business Fax Number: | 7042632591 |
Mailing Address: | 700 N Main St, STANLEY |
State: | NC |
Postal Code: | 281641438 |
Phone Number: | 7042638945 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2012 |
NPI Last Update Date: | 03/21/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5005686 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |