Healthcare Provider Details

I. General information

NPI: 1780669309
Provider Name (Legal Business Name): SHARON A AUSTIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 6TH ST
MINONK IL
61760-1308
US

IV. Provider business mailing address

301 S BLOOMINGTON ST
STREATOR IL
61364-2904
US

V. Phone/Fax

Practice location:
  • Phone: 309-432-2441
  • Fax: 309-432-3711
Mailing address:
  • Phone: 815-673-2441
  • Fax: 815-672-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number309000390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: