Healthcare Provider Details

I. General information

NPI: 1285043059
Provider Name (Legal Business Name): SHARON J WHITEFAWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5362 LEMEE LANE
MARIPOSA CA
95338-0099
US

IV. Provider business mailing address

P O BOX 99
MARIPOSA CA
95338-0099
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-2000
  • Fax: 209-966-8251
Mailing address:
  • Phone: 209-966-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: