Healthcare Provider Details

I. General information

NPI: 1063508703
Provider Name (Legal Business Name): SHARON KIMBALL RNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 IVY ST
GRASS VALLEY CA
95945-6126
US

IV. Provider business mailing address

536 IVY ST
GRASS VALLEY CA
95945-6126
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5638
  • Fax: 415-206-4562
Mailing address:
  • Phone: 415-206-5638
  • Fax: 415-206-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number326484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number326484/7362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: