Healthcare Provider Details

I. General information

NPI: 1396609574
Provider Name (Legal Business Name): SHARON SHAMBURG-KOUANOU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

2404 DENVER AVE
SPIRIT LAKE IA
51360-2020
US

IV. Provider business mailing address

2404 DENVER AVE
SPIRIT LAKE IA
51360-2020
US

V. Phone/Fax

Practice location:
  • Phone: 785-738-7921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: