Sally, Dedra

Sally, Dedra is an individual health care provider with primary practice located at 10010 Falls Of Neuse Rd Suite 205, Raleigh NC 27614-8494. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Sally, Dedra can be contacted via phone (919) 350-1380.

Contact Information

Primary practice address
10010 Falls Of Neuse Rd Suite 205 Raleigh NC 27614-8494
Phone: (919) 350-1380
Fax: (919) 350-7918
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 25ME00056001 New Jersey
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 25ME00056000 New Jersey
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 583 North Carolina

Profile Details

NPI number 1821492315
LBN Legal business name Sally, Dedra
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2014
Last updated Jun 21st, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821492315 NPPES
North Carolina MEDICAID 1821492315

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