Healthcare Provider Details

I. General information

NPI: 1730121666
Provider Name (Legal Business Name): SHARON ELIASON MADDREY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 JENNIFER LN
PERRY GA
31069-9627
US

IV. Provider business mailing address

118 JENNIFER LN
PERRY GA
31069-9627
US

V. Phone/Fax

Practice location:
  • Phone: 478-218-5486
  • Fax:
Mailing address:
  • Phone: 478-218-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN160682
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1655482
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28187322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: