Healthcare Provider Details

I. General information

NPI: 1235219239
Provider Name (Legal Business Name): SHARON FAYE DEBUREN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 VIA LOS ALTOS
TIBURON CA
94920-2059
US

IV. Provider business mailing address

35 VIA LOS ALTOS
TIBURON CA
94920-2059
US

V. Phone/Fax

Practice location:
  • Phone: 415-383-1405
  • Fax:
Mailing address:
  • Phone: 415-383-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberV163669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: