Healthcare Provider Details

I. General information

NPI: 1184629891
Provider Name (Legal Business Name): SHARON K KLINGERMAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NAVARRE PL STE 5550
SOUTH BEND IN
46601-1169
US

IV. Provider business mailing address

100 NAVARRE PL STE 6695
SOUTH BEND IN
46601-1169
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-5123
  • Fax:
Mailing address:
  • Phone: 800-860-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000538A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: