Healthcare Provider Details

I. General information

NPI: 1063828283
Provider Name (Legal Business Name): JAYNA LYNN SHARPLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4757 WILLIS RD APT 2
GRASS LAKE MI
49240-9684
US

IV. Provider business mailing address

4757 WILLIS RD APT 2
GRASS LAKE MI
49240-9684
US

V. Phone/Fax

Practice location:
  • Phone: 517-438-0032
  • Fax:
Mailing address:
  • Phone: 517-438-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704186463
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9356053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: