Healthcare Provider Details

I. General information

NPI: 1245448810
Provider Name (Legal Business Name): SHARON GORTON L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S WESTNEDGE AVE
KALAMAZOO MI
49008-1166
US

IV. Provider business mailing address

PO BOX 295
RICHLAND MI
49083-0295
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-4458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703083271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: