Healthcare Provider Details

I. General information

NPI: 1467635508
Provider Name (Legal Business Name): SHARON WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8583
  • Fax:
Mailing address:
  • Phone: 916-734-8583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG57949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: