Healthcare Provider Details

I. General information

NPI: 1134561657
Provider Name (Legal Business Name): SHARON HAYA MADJAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

IV. Provider business mailing address

200 W SPRING ST
MARQUETTE MI
49855-4630
US

V. Phone/Fax

Practice location:
  • Phone: 906-233-1322
  • Fax: 906-233-1220
Mailing address:
  • Phone: 906-233-1322
  • Fax: 906-233-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704261348
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: