Healthcare Provider Details

I. General information

NPI: 1215293378
Provider Name (Legal Business Name): SHARON DENISE WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N DOUGLASS ST
MALDEN MO
63863-1512
US

IV. Provider business mailing address

806 N DOUGLASS ST
MALDEN MO
63863-1512
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-3873
  • Fax: 573-276-4212
Mailing address:
  • Phone: 573-276-3873
  • Fax: 573-276-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012009566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: