Healthcare Provider Details

I. General information

NPI: 1689720013
Provider Name (Legal Business Name): SHARON R ANDROES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 LEISURE DR
KALISPELL MT
59901-7587
US

IV. Provider business mailing address

PO BOX 3277
KALISPELL MT
59903-3277
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-3413
  • Fax:
Mailing address:
  • Phone: 406-752-3413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number8385
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: