Healthcare Provider Details

I. General information

NPI: 1487241956
Provider Name (Legal Business Name): ABIGAIL LEE SHARP ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 04/15/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 E MAIN ST
MARSHALLTOWN IA
50158-1928
US

IV. Provider business mailing address

405 E MAIN ST
MARSHALLTOWN IA
50158-1928
US

V. Phone/Fax

Practice location:
  • Phone: 641-753-2752
  • Fax: 641-753-6450
Mailing address:
  • Phone: 641-753-2752
  • Fax: 641-753-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA162438
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number147640
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: