Healthcare Provider Details

I. General information

NPI: 1346466414
Provider Name (Legal Business Name): SHARON LYNNE NUGENT RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S LINDBERGH BLVD
SAINT LOUIS MO
63131-3504
US

IV. Provider business mailing address

PO BOX 8500, LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 314-432-3600
  • Fax: 314-872-7808
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number061340
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: