Healthcare Provider Details

I. General information

NPI: 1265016992
Provider Name (Legal Business Name): SHARON R HASTING APN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1639 N ALPINE RD STE 403
ROCKFORD IL
61107-1440
US

IV. Provider business mailing address

13216 E KRISE RD
STOCKTON IL
61085-9403
US

V. Phone/Fax

Practice location:
  • Phone: 815-965-8505
  • Fax: 815-965-8440
Mailing address:
  • Phone: 815-990-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: SHARON R HASTING
Title or Position: OWNER
Credential: APRN-FPA
Phone: 815-990-3276