Healthcare Provider Details

I. General information

NPI: 1275534570
Provider Name (Legal Business Name): CAROL LYNN SHARP R.N. / OGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S LAKEVIEW ST SUITE 207
STURGIS MI
49091-2371
US

IV. Provider business mailing address

600 S LAKEVIEW ST SUITE 207
STURGIS MI
49091-2371
US

V. Phone/Fax

Practice location:
  • Phone: 269-659-4646
  • Fax: 269-651-2210
Mailing address:
  • Phone: 269-659-4646
  • Fax: 269-651-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704155434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: