Healthcare Provider Details

I. General information

NPI: 1720381734
Provider Name (Legal Business Name): SHARINA BROTHERS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CRETIN AVE S
SAINT PAUL MN
55105-1259
US

IV. Provider business mailing address

236 CRETIN AVE S
SAINT PAUL MN
55105-1259
US

V. Phone/Fax

Practice location:
  • Phone: 612-440-7710
  • Fax:
Mailing address:
  • Phone: 612-440-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number60193321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: