Healthcare Provider Details

I. General information

NPI: 1700149937
Provider Name (Legal Business Name): SHARON HODGES-RUST LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 E FORDHAM DR
TUCSON AZ
85710-8754
US

IV. Provider business mailing address

6417 E FORDHAM DR
TUCSON AZ
85710-8754
US

V. Phone/Fax

Practice location:
  • Phone: 520-409-4877
  • Fax: 520-284-9297
Mailing address:
  • Phone: 520-409-4877
  • Fax: 520-284-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM171
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: